Active NPI
Jennifer Renea Wallace, B.A
- Counselor
- Durant, OK
National Provider Identifier
1669799086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 3802 W University Blvd Apt 8104
Durant, OK 74701-3047 - Phone
- (580) 465-5961
- NPI assigned
- Apr 24, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | OK | Primary |
Addresses
Primary practice location
3802 W University Blvd Apt 8104
Durant, OK 74701-3047
Mailing address
3802 W University Blvd Apt 8104
Durant, OK 74701-3047
Phone (580) 465-5961
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272067200000",
"number": "1669799086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3802 W UNIVERSITY BLVD APT 8104",
"city": "DURANT",
"state": "OK",
"postal_code": "747013047",
"telephone_number": "580-465-5961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3802 W UNIVERSITY BLVD APT 8104",
"city": "DURANT",
"state": "OK",
"postal_code": "747013047",
"telephone_number": "580-465-5961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JENNIFER",
"middle_name": "RENEA",
"credential": "B.A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-24",
"last_updated": "2010-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OK",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durant, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.