Provider Demographics
NPI:1265855498
Name:KJOSE, ANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:KJOSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 NW 63RD ST STE 227
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3631
Mailing Address - Country:US
Mailing Address - Phone:405-242-6460
Mailing Address - Fax:405-212-4463
Practice Address - Street 1:3035 NW 63RD ST STE 227
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3631
Practice Address - Country:US
Practice Address - Phone:405-242-6460
Practice Address - Fax:405-212-4463
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
OK1371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health