Jefferies Blake Davis
Individual provider Active NPI Peer Specialist · Newalla, OK
NPI 1003430869 · NPPES record last updated Jun 8, 2020
Key facts
- NPI
- 1003430869
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 10700 S Choctaw Rd
Newalla, OK 74857-7962 - Phone
- (405) 742-7713
- NPI assigned
- Jun 7, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope Community Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
10700 S Choctaw Rd
Newalla, OK 74857-7962
Mailing address
7701 S Anderson Rd
Oklahoma City, OK 73150-6708
Phone (405) 742-7713
Other practice location 1
7701 S Anderson Rd
Oklahoma City, OK 73150-6708
Phone (405) 742-7713
Other providers in Newalla, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.