Individual
KACEE JADE PLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BACHELOR OF SCIENCE
Contact information
Practice address
104 STACY ST, WISTER, OK 74966-9566
(918) 413-2658
Mailing address
104 STACY ST, WISTER, OK 74966-9566
(918) 413-2658
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
08/21/2023
Last updated
08/21/2023
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