Healthcare Provider Details

I. General information

NPI: 1346793924
Provider Name (Legal Business Name): JERMEKA GUMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 E 21ST ST
TULSA OK
74129-1820
US

IV. Provider business mailing address

7777 S LEWIS AVE
TULSA OK
74171-0001
US

V. Phone/Fax

Practice location:
  • Phone: 918-437-9495
  • Fax:
Mailing address:
  • Phone: 352-301-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: