Jennifer Green

Individual provider Active NPI Case Manager/Care Coordinator · Caddo, OK

NPI 1730560459 · NPPES record last updated Jun 18, 2015

Key facts

NPI
1730560459
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
Practice address
610 Russell Rd
Caddo, OK 74729-1111
Phone
(580) 230-8945
Fax
(918) 465-0301
NPI assigned
Jun 18, 2015
Sex
Female
Sole proprietor
Yes

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)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Yes

Addresses

Primary practice location

610 Russell Rd
Caddo, OK 74729-1111

Mailing address

610 Russell Rd
Caddo, OK 74729-1111

Other providers in Caddo, OK

All providers in Caddo, OK · Case Manager/Care Coordinator in Oklahoma

Sources for this page

Verify at the official NPI Registry.