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NPI Code Detail

MEDICARE: DR. JACKIE LYNN NEEL DO

MEDICARE: DR. JACKIE LYNN NEEL DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician2108OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
239745OTHERCIGNA BEHAVIORAL HEALTH
34306557OTHERAETNA BEHAVIORAL HEALTH

General Provider Information

NPI Number : 1023088176
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACKIE LYNN NEEL DO
Provider Business Mailing Address
First Line : PO BOX 21228
Second Line : DEPT 31
City : TULSA
State : OK
Zip : 74121-1228
Country : US
Telephone Number : 918-502-5052
Fax Number : 918-502-5060
Provider Business Practice Location Address
First Line : 6655 S YALE AVE
Second Line : LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
City : TULSA
State : OK
Zip : 74136-3326
Country : US
Telephone Number : 918-502-5052
Fax Number : 918-502-5060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 01/31/2017

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