JERRY MEDLOCK (NPI# 1285164392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 175T00000X | Peer Specialist | Other Service Providers |
Street Address |
4312 VFW DR. APT # 7 4312 VFW DR. APT # 7 |
City | DEL CITY |
State | OK |
Zip Code | 73115 |
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 |
Find all providers in zip 73115 |
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 |
---|---|---|---|---|
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 |
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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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.