Provider Demographics
NPI:1538490313
Name:ZACKERY, RODNEY JAMES
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:JAMES
Last Name:ZACKERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W. COMMERCE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5104
Mailing Address - Country:US
Mailing Address - Phone:405-354-2814
Mailing Address - Fax:405-354-3196
Practice Address - Street 1:4400 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5104
Practice Address - Country:US
Practice Address - Phone:405-354-2814
Practice Address - Fax:405-354-3196
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health