Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 238194 | OK |
NPI | 1063877736 |
---|---|
Provider Name | Mrs. Jazmine Rena O'kelley |
First Address | Cushing, OK 74023 |
Second Address | Cushing, OK 74023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2015 |
Last Update Date | 23/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100686560A | (05) | OK |