Healthcare Provider Details

I. General information

NPI: 1245159599
Provider Name (Legal Business Name): JEREMY MICHAEL DICKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 NW 150TH ST APT 44B
OKLAHOMA CITY OK
73134-2020
US

IV. Provider business mailing address

3101 NW 150TH ST APT 44B
OKLAHOMA CITY OK
73134-2020
US

V. Phone/Fax

Practice location:
  • Phone: 405-802-0256
  • Fax:
Mailing address:
  • Phone: 405-802-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: