Individual
JAKE COPELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 S CENTRAL AVE, IDABEL, OK 74745-6060
(580) 286-2000
Mailing address
412 S CENTRAL AVE, IDABEL, OK 74745-6060
(580) 286-2000
(580) 286-2002
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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