Individual
JENNIFER SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10821 WEST HICKORY AVENUE, PEGGS SCHOOL, PEGGS, OK 74452
(918) 260-0199
Mailing address
PO BOX 119, PEGGS, OK 74452-0119
(918) 598-3412
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047434244
—
OK
Enumeration date
03/03/2016
Last updated
03/03/2016
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