Most Relevant Information
Provider Data
| NPI Number: | 1003360884 |
| Provider Name: | JESSE SMITH SPECIAL CARE PARA |
| Entity Type: | Individual |
| Taxonomy Code: | 376K00000X |
| Specialty: | Nurse's Aide |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/09/2016 |
| Last Updated: | 08/09/2016 |
Provider Practice Location
225 N WATER AVE
TAHLEQUAH
OK
744642825
Practice Location Phone/Fax
| Phone: | 9184584100 |
| Fax: |
Provider Mailing Location
225 N WATER AVE
TAHLEQUAH
OK
744642825
Provider Mailing Phone/Fax
| Phone: | 9184584100 |
| Fax: |