Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | LO50 | OK |
N | 222Z00000X | Podiatrist | LO50 | OK |
Y | 224P00000X | Prosthetist | LP37 | OK |
NPI | 1154670677 |
---|---|
Provider Name | Mrs. Jennifer Diane Talbert |
First Address | Oklahoma City, OK 73134-1761 |
Second Address | Oklahoma City, OK 73134-1761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2012 |
Last Update Date | 08/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO03055 | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS (01) |