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NPI Code Detail

MEDICARE: STACEY JIMENEZ

MEDICARE: STACEY JIMENEZ
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1881407864
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY JIMENEZ
Provider Business Mailing Address
First Line : 6504 ROCK CREEK CIR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73132-2004
Country : US
Telephone Number : 405-503-7606
Fax Number :
Provider Business Practice Location Address
First Line : 6504 ROCK CREEK CIR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73132-2004
Country : US
Telephone Number : 405-503-7606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2025
Last Update Date : 01/31/2025

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Directions to “ STACEY JIMENEZ ” Practice Location

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