Individual
MS. KATELYNN JORDAN CHURCHES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 W KEETOOWAH ST, TAHLEQUAH, OK 74464-3820
(918) 201-4333
Mailing address
1646 STERN RD LOT 14, TAHLEQUAH, OK 74464-6522
(918) 871-7312
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134704489
—
OK
Enumeration date
10/26/2021
Last updated
10/26/2021
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