Individual
JACQUELYNN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 N 4TH ST, PONCA CITY, OK 74601
(405) 372-2202
(580) 215-5765
Mailing address
110 N 4TH ST, PONCA CITY, OK 74601-4527
(405) 372-2202
(580) 215-5765
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/11/2018
Last updated
05/20/2019
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