Zachary Blackowl
Individual provider Active NPI Peer Specialist · El Reno, OK
NPI 1679386296 · NPPES record last updated Jan 28, 2025
Key facts
- NPI
- 1679386296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Peer Specialist 175T00000X
- Practice address
- 1950 S Shepard Ave
El Reno, OK 73036-6357 - Phone
- (405) 365-7709
- NPI assigned
- Jan 28, 2025
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | Yes |
Addresses
Primary practice location
1950 S Shepard Ave
El Reno, OK 73036-6357
Mailing address
1108 Skyview Dr
El Reno, OK 73036-2026
Phone (405) 202-8957
Other providers in El Reno, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2025. 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.