1972768299 NPI number — MRS. JENIFER RENEE SKEANS CSFA

Table of content: MRS. JENIFER RENEE SKEANS CSFA (NPI 1972768299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972768299 NPI number — MRS. JENIFER RENEE SKEANS CSFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKEANS
Provider First Name:
JENIFER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CSFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAY SKEANS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972768299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6515 S. 250TH EAST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-289-8422
Provider Business Mailing Address Fax Number:
918-286-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6515 S. 250TH EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN ARROW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-289-8422
Provider Business Practice Location Address Fax Number:
918-286-0077
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZS0410X , with the licence number:  171496 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246ZS0410X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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