Healthcare Provider Details

I. General information

NPI: 1518330562
Provider Name (Legal Business Name): JO ACREE MOORE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO NELL ACREE M.S.

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 W ROCK CREEK RD STE 110B
NORMAN OK
73072-2202
US

IV. Provider business mailing address

2901 N GROVE AVE
OKLAHOMA CITY OK
73127-1748
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-2684
  • Fax: 405-607-3530
Mailing address:
  • Phone: 405-519-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number4376
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: