JEANNIE LONG (NPI# 1164904710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164904710 |
| Entity Type | Individual |
| Full Name | JEANNIE LONG |
| Practice Address |
1095 Nickerson St Waynoka OK 73860-1252 |
| Mailing Address |
Po Box 135 Waynoka OK 73860-0135 |
| Practice Telephone | 5808240674 |
| Mailing Telephone | 5808240676 |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2018-08-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992198485 | Jeannie Long | Behavioral Analyst | 1161 N El Dorado Pl # 103, Tucson, AZ 85715-4607 | 2015-03-09 |
| 1073890786 | Jeannie Long | Social Worker | 5808 W 110th St, Overland Park, KS 66211-2504 | 2011-11-09 |
| Street Address |
1095 NICKERSON ST |
| City | WAYNOKA |
| State | OK |
| Zip Code | 73860-1252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780718478 | Lois Arleta Smith | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2007-03-15 |
| 1063026433 | Kohannah Hess | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2020-09-03 |
| 1134750698 | Mackenzie Rae Brune | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2020-02-03 |
| 1649835869 | Jordan Cremers | Peer Specialist | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2019-05-02 |
| 1871075143 | Tamara Bolar | Peer Specialist | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2018-09-04 |
| 1205320140 | Clarissa M Fifield | Social Worker | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2018-06-14 |
| 1437640596 | Marissa Hofen | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2018-05-24 |
| 1477089720 | Brooke D Laird | Counselor | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2017-05-05 |
| 1780115162 | Patricia Byrd | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2017-03-27 |
| 1225581077 | Jamie Dawn Wreath | Case Manager/Care Coordinator | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2016-07-28 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538638648 | Milissa A Britt | Case Manager/Care Coordinator | 500 S Nickerson, Waynoka, OK 73860 | 2018-11-19 |
| 1619470507 | Shonda Russell | Case Management | 1095 S. Nickerson St., Waynoka, OK 73860 | 2018-03-16 |
| 1962660738 | Susan M Hull | Internal Medicine | 1630 Santa Fe, Waynoka, OK 73860 | 2008-05-29 |
| 1588669428 | Charlene Elaine Reust | Physician Assistant | 1084 Nickerson St, Waynoka, OK 73860 | 2005-06-16 |
| 1518421668 | Dian Linnea Frey | Case Manager/Care Coordinator | 500 S Nickerson, Waynoka, OK 73860 | 2019-01-23 |
| 1760450472 | Elizabeth Romanik Kinzie | Internal Medicine | 1084 Nickerson St, Waynoka, OK 73860 | 2006-03-09 |
| 1790028496 | The Medical Clinic, Inc | Clinic/Center | 1630 Santa Fe St., Waynoka, OK 73860-0000 | 2013-04-01 |
| 1043213002 | City of Waynoka | Ambulance | 201 E Cecil St, Waynoka, OK 73860-1233 | 2005-05-24 |
| 1124029293 | Integris Bass Baptist Health Center | Family Medicine | 1084 Nickerson St, Waynoka, OK 73860-1245 | 2005-08-10 |
| 1427059179 | Jeffery S Schwerdtfeger | Physician Assistant | 1084 Nickerson St, Waynoka, OK 73860-1245 | 2005-08-03 |
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| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013480151 | Christy Jo Hood | Peer Specialist | 2216 Santa Fe St, Waynoka, OK 73860-3910 | 2019-01-10 |
| 1649835869 | Jordan Cremers | Peer Specialist | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2019-05-02 |
| 1871075143 | Tamara Bolar | Peer Specialist | 1095 Nickerson St, Waynoka, OK 73860-1252 | 2018-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972537 | Tamra Lynn Cunningham | Peer Specialist | 764 Sherwin Ave, Ponca City, OK 74604-6112 | 2020-11-05 |
| 1699375691 | Martha Isabel Zapata | Peer Specialist | 5740 E 72nd Ct, Tulsa, OK 74136-7202 | 2020-10-28 |
| 1376143883 | Tina Marie Lopez | Peer Specialist | 933 N Oak St, Ponca City, OK 74601-3218 | 2020-10-26 |
| 1518566264 | Vincent Oaks Cox | Peer Specialist | 3585 S 439, Pryor, OK 74361-9346 | 2020-10-23 |
| 1558960146 | Sarah Elizabeth Walters | Peer Specialist | 2139 W Jasper St Apt B1, Broken Arrow, OK 74011-8028 | 2020-10-23 |
| 1861091548 | Ryan Vanmeter | Peer Specialist | 1965 Ladera Ln, Edmond, OK 73034-9787 | 2020-10-22 |
| 1255930038 | Brandon Loyd Hopkins | Peer Specialist | 446 S Scraper St, Vinita, OK 74301-4250 | 2020-10-22 |
| 1225637366 | Crystal Dawn Adams | Peer Specialist | 200 N Sante Fe Ave, Bartlesville, OK 74003 | 2020-10-20 |
| 1194324491 | Judith Anne Young | Peer Specialist | 3934 Se 27th St, Del City, OK 73115-2620 | 2020-10-19 |
| 1407455892 | Kristen Michelle Stock | Peer Specialist | 804 N Dryden Cir, Stillwater, OK 74075-7108 | 2020-10-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.