JERRY MEDLOCK


Address: 4312 Vfw Dr. Apt # 7, 4312 Vfw Dr. Apt # 7, Del City, OK 73115
Phone: (405) 468-0922

JERRY MEDLOCK (NPI# 1285164392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1285164392
Entity Type Individual
Full Name JERRY MEDLOCK
Practice Address 4312 Vfw Dr. Apt # 7
4312 Vfw Dr. Apt # 7
Del City
OK 73115
Mailing Address 4312 Vfw Dr Apt 7
Del City
OK 73115-2139
Practice Telephone (405) 468-0922
Mailing Telephone 4054680922
Enumeration Date 2017-06-13
Last Update Date 2017-06-13
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 175T00000X Peer Specialist Other Service Providers

Office Location

Street Address 4312 VFW DR. APT # 7
4312 VFW DR. APT # 7
City DEL CITY
State OK
Zip Code 73115

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1639776222 Physicians Choice Dialysis of Midwest City LLC Technician, Other 3200 Se 29th Street, Del City, OK 73115 2020-10-06
1942784715 Iacc/ehi Nw, LLC General Acute Care Hospital 4801 S.e. 15th Street, Del City, OK 73115 2018-09-18
1326425588 Peace of Mind Pediatrics Pllc Clinic/Center 5476 Main Street, 104, Del City, OK 73115 2015-04-27
1588077044 Latasha Aujena Walker Case Management 4337 Se15th, Del City, OK 73115 2014-06-03
1164834701 Affordable Dentures-midwest City, P.C. Dentist 5301 Main Street, Suite 111, Del City, OK 73115 2014-06-02
1629488028 Nikke Sogunro Counselor 3517 Ridglea Ct., Del City, OK 73115 2014-05-07
1033539358 Shelli Holtsman Counselor 4329 Se 40th Street, Del City, OK 73115 2014-04-25
1215238514 Tonya Dailwayne Wilson Counselor 4016 S.e. 24th Street, Del City, OK 73115 2010-11-03
1851611099 Kelly Camille Kingsley Behavioral Analyst 4018 Se 11th Street, Del City, OK 73115 2010-06-10
1275852568 Tanya Skelly Counselor 900 Nw 10th Street, Oklahoma City, OK 73115 2010-05-26
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Taxonomy Information

Taxonomy Code 175T00000X
Grouping Other Service Providers
Classification Peer Specialist

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1194324491 Judith Anne Young Peer Specialist 3934 Se 27th St, Del City, OK 73115-2620 2020-10-19
1649741232 Lora Jane Williams Peer Specialist 3101 Tinker Diagonal, Del City, OK 73115-1019 2018-12-08
1346720299 Dillon Trey Jarrett Peer Specialist 1413 Shalimar Dr, Del City, OK 73115-4952 2018-08-20
1023552700 Latonya L Lewis Peer Specialist 3324 S Bryant Ave, Apt134, Del City, OK 73115-1705 2016-12-14
1336747609 Shane Palmer Braig Peer Specialist 5113 Se 15th St Ste A, Del City, OK 73115-3952 2020-10-09
1215553342 Christopher Lee Campbell Peer Specialist 5505 Main St, Del City, OK 73115-5509 2020-06-24

Providers in the same taxonomy and state

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
1407455892 Kristen Michelle Stock Peer Specialist 804 N Dryden Cir, Stillwater, OK 74075-7108 2020-10-18
1275131823 Deena June Patrick Peer Specialist 2536 N Boston Ave, Tulsa, OK 74106-3609 2020-10-15
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Competitor

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City DEL CITY
Zip Code 73115

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Dataset Information

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.

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