Individual
SANDRA JERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FSP
Contact information
Practice address
401 N CHURCH ST, SUITE K, POTEAU, OK 74953-3502
(918) 649-0230
(918) 649-1492
Mailing address
107 S HIGH ST, ANTLERS, OK 74523-3818
(580) 298-2830
(580) 298-6723
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100744370
—
OK
Enumeration date
04/27/2017
Last updated
04/27/2017
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