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General NPI Number Information
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NPI Number | 1578432837
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Entity Type | Individual
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Provider Name | JACOB JOEL PARKER
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Gender | Male
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 405 E EXCELSIOR AVE
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City | VINITA
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State | OK
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Zip | 74301-4226
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Country | US
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Telephone | 844-458-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 S MADISON BLVD APT 306
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City | BARTLESVILLE
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State | OK
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Zip | 74006-7921
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Country | US
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Telephone | 918-261-9613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 37V103297101
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 37V735271116
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License Number State | OK
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