Provider Demographics
NPI:1043437163
Name:CONNER, JENNIFER II
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CONNER
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:54311 MOCCASIN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14453 SE 29TH ST STE D
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-6543
Practice Address - Country:US
Practice Address - Phone:405-741-2844
Practice Address - Fax:405-733-1334
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor