Healthcare Provider Details

I. General information

NPI: 1790416550
Provider Name (Legal Business Name): JORDAN HOPKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 GENERAL PERSHING BLVD
OKLAHOMA CITY OK
73107-6437
US

IV. Provider business mailing address

1929 MELANIE DR
OKLAHOMA CITY OK
73127-3214
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2700
  • Fax:
Mailing address:
  • Phone: 620-218-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: