Healthcare Provider Details

I. General information

NPI: 1891959276
Provider Name (Legal Business Name): JERRI L VENABLE B.S., CMII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JERRI L BARNARD B.S., CADC, CM-II

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/13/2020
Certification Date: 07/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

IV. Provider business mailing address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-8080
  • Fax: 918-337-8099
Mailing address:
  • Phone: 918-337-8080
  • Fax: 918-337-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number314252
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: