Healthcare Provider Details

I. General information

NPI: 1902735996
Provider Name (Legal Business Name): JAYDEE LYN TERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10321 N 2274 RD
CLINTON OK
73601-7521
US

IV. Provider business mailing address

1105 E PROCTOR AVE
WEATHERFORD OK
73096-5732
US

V. Phone/Fax

Practice location:
  • Phone: 580-660-0336
  • Fax:
Mailing address:
  • Phone: 580-331-3485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: