Individual
JEROMY RYAN SCOFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1900 N 14TH ST, PONCA CITY, OK 74601-2035
(316) 519-3770
Mailing address
6539 S OLIVER ST, DERBY, KS 67037-9071
(316) 519-3770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
116018
OK
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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