Individual
JACQUELYN MICHELLE KELLY HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
517 S 64TH ST, BROKEN ARROW, OK 74014-2664
(714) 430-0157
Mailing address
517 S 64TH ST, BROKEN ARROW, OK 74014-2664
(714) 430-0157
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/27/2023
Last updated
04/27/2023
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