Individual
JESSICA NEELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
403030 W 2700 RD, RAMONA, OK 74061-3543
(470) 214-6118
Mailing address
403030 W 2700 RD, RAMONA, OK 74061-3543
(470) 214-6118
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
H083291088
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H083291088
H083291088
OK
Enumeration date
03/11/2016
Last updated
03/11/2016
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