Individual
JERRY WAYNE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 S ADAIR ST, PRYOR, OK 74361-5201
(918) 803-2779
Mailing address
901 S ELLIOTT ST, PRYOR, OK 74361-7003
(918) 944-9970
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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