Provider Demographics
NPI:1417214578
Name:KIZER, NANCY JEAN
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEAN
Last Name:KIZER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:KILPATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O.BOZ321
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74038
Mailing Address - Country:US
Mailing Address - Phone:918-935-9934
Mailing Address - Fax:
Practice Address - Street 1:808 OAK
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:OK
Practice Address - Zip Code:74038
Practice Address - Country:US
Practice Address - Phone:918-935-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK324500000X324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility