Individual
JIMMIE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4913 W RENO AVE, OKLAHOMA CITY, OK 73127-6339
(405) 948-4900
(405) 948-4933
Mailing address
4913 W RENO AVE, OKLAHOMA CITY, OK 73127-6339
(405) 948-4900
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/11/2017
Last updated
12/22/2020
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