Healthcare Provider Details

I. General information

NPI: 1245776905
Provider Name (Legal Business Name): JERMAINE BARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 CIMARRON DR
OKLAHOMA CITY OK
73162-2344
US

IV. Provider business mailing address

11301 CIMARRON DR
OKLAHOMA CITY OK
73162-2344
US

V. Phone/Fax

Practice location:
  • Phone: 405-900-3199
  • Fax:
Mailing address:
  • Phone: 405-990-3199
  • Fax: 405-601-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: