1386994473 NPI number — JENNIFER KELLILYN FARMER B.H.R.S.

Table of content: JENNIFER KELLILYN FARMER B.H.R.S. (NPI 1386994473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386994473 NPI number — JENNIFER KELLILYN FARMER B.H.R.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARMER
Provider First Name:
JENNIFER
Provider Middle Name:
KELLILYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.H.R.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARMER
Provider Other First Name:
KELLI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386994473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9803 E 84TH ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWASSO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74055-2355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-906-8614
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9803 E 84TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-2355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-906-8614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2012

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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