Jennifer Russell

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

118 E Main St
Holdenville, OK 74848-3208

Phone

(405) 379-5256

NPI assigned

Aug 30, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Oklahoma Families First Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ardmore, OK
  • NPI 1790887602
  NPD (past)

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1356061469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 OKLAHOMA AVE",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748845088",
            "telephone_number": "405-738-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E MAIN ST",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748483208",
            "telephone_number": "405-379-5256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pruett'S Food, Inc.
• Jimmie Ray Rodgers
• Karis Ashley Rodriguez, APRN CNP
• Mark Jeremy Rosengren, D.O.
• Rural Area Counseling Center
• Sanderling Renal Services of Holdenville
• Fred Steven Sanders, DO
• Erika Glyn Seeley
• Don A Shields, DC
• Joanna Sullivan

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.