Individual
JESSICA RENEE DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 MONROE ST APT 21, TAHLEQUAH, OK 74464-5649
(918) 570-6334
Mailing address
200 MONROE ST APT 21, TAHLEQUAH, OK 74464-5649
(918) 570-6334
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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