1811588809 NPI number — JENNIFER LYNN PURSELL LEMON M.ED.

Table of content: JENNIFER LYNN PURSELL LEMON M.ED. (NPI 1811588809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811588809 NPI number — JENNIFER LYNN PURSELL LEMON M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMON
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN PURSELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYD
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYN PURSELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811588809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7510 BROADWAY EXT STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73116-9031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-418-8522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4450 BUFFALO HL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUTHRIE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73044-9511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-418-8522
Provider Business Practice Location Address Fax Number:
405-418-8665
Provider Enumeration Date:
02/01/2021

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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