Individual
DR. JOHN PAUL HENNESSEE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3224 SW 119TH ST STE A, OKLAHOMA CITY, OK 73170-4546
(405) 759-3880
(405) 759-3882
Mailing address
PO BOX 891868, SUITE A, OKLAHOMA CITY, OK 73189-1868
(405) 759-3880
(405) 759-3882
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
18494
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090940A
—
OK
01
—
900522056
MEDICARE NUMBER
OK
Enumeration date
06/28/2006
Last updated
09/30/2022
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