Healthcare Provider Details

I. General information

NPI: 1235644345
Provider Name (Legal Business Name): JENNIFER R HILL LADC-UNDER SUPERVISI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 S GARNETT RD STE 200
TULSA OK
74146-6830
US

IV. Provider business mailing address

5550 S GARNETT RD STE 200
TULSA OK
74146-6830
US

V. Phone/Fax

Practice location:
  • Phone: 918-665-2501
  • Fax: 918-665-3966
Mailing address:
  • Phone: 918-665-2501
  • Fax: 918-665-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: