Provider Demographics
NPI:1104198241
Name:FOGLE, JAMI BETH (MED)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:BETH
Last Name:FOGLE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:4710 S. DIVISION
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-1558
Mailing Address - Country:US
Mailing Address - Phone:405-282-5524
Mailing Address - Fax:
Practice Address - Street 1:4710 S DIVISION ST
Practice Address - Street 2:4710 S. DIVISION
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6506
Practice Address - Country:US
Practice Address - Phone:405-282-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst