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NPI Code Detail

MEDICARE: JACOB REAVIS CODY JACOB REAVIS

MEDICARE: JACOB REAVIS CODY JACOB REAVIS
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
1171M00000XCase Manager/Care CoordinatorOK

General Provider Information

NPI Number : 1588514269
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB REAVIS CODY JACOB REAVIS
Provider Business Mailing Address
First Line : 6909 NW 43RD ST
Second Line :
City : BETHANY
State : OK
Zip : 73008-2454
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 201 NE 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-1811
Country : US
Telephone Number : 405-235-7537
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ JACOB REAVIS CODY JACOB REAVIS ” Practice Location

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