Individual
JAYNI ELLEN GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1212 REYNOLDS AVE, POTEAU, OK 74953-4724
(918) 649-0172
Mailing address
1620 TERRACE DR, DUNCAN, OK 73533-1324
(580) 736-5515
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
47302
OK
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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