Healthcare Provider Details

I. General information

NPI: 1255291548
Provider Name (Legal Business Name): JEANETTEA TRAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/19/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10802 QUAIL PLAZA DR STE 208
OKLAHOMA CITY OK
73120-3121
US

IV. Provider business mailing address

1601 SW 65TH ST
OKLAHOMA CITY OK
73159-3111
US

V. Phone/Fax

Practice location:
  • Phone: 405-889-3571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: