MEDICARE: JAYNA L PARKER

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
1	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00808353	OTHER	TX	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1255763165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYNA L PARKER

Provider Business Mailing Address
First Line	:	2224 HOUSTON AVE APT 5
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-3308
Country	:	US
Telephone Number	:	832-563-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	2224 HOUSTON AVE APT 5
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-3308
Country	:	US
Telephone Number	:	832-563-7789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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Directions to “ JAYNA L PARKER ” Practice Location

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