Jaclyn Nichole Purnell

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

118 W Keetoowah St
Tahlequah, OK 74464-3820

Phone

(918) 708-2015

NPI assigned

Jul 13, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Quah Prevention and Recovery Center, Inc.

  • Case Management Agency
  • Tahlequah, OK
  • NPI 1134704489
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1194459362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 LINN AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744672132",
            "telephone_number": "405-220-7173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 W KEETOOWAH ST",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744643820",
            "telephone_number": "918-708-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PURNELL",
        "first_name": "JACLYN",
        "middle_name": "NICHOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Prodigy Foundation
• Prosper OT Consultation Services, LLC
• Dana Pruet
• Terri Amanda Pruitt, APRN-CNP
• Bruce Edward Pullen, DPH
• Quah Prevention and Recovery Center, Inc.
• Qualls & Associates, Inc.
• Elaine Mary Quintana, M.D.
• Charlene Radebaugh, LPC
• Paul Edward Rader, D.D.S.

• Peer Specialist in Tahlequah, OK
• Providers in Tahlequah, OK by specialty
• Peer Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.