Healthcare Provider Details

I. General information

NPI: 1053232322
Provider Name (Legal Business Name): ADAMARI KYMBERLY JASSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E MAIN PL
JENKS OK
74037
US

IV. Provider business mailing address

6722 S ROCKFORD PL
TULSA OK
74136-3849
US

V. Phone/Fax

Practice location:
  • Phone: 918-209-5190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: