Provider Demographics
NPI:1598265605
Name:KIZZIAR, JENNY RAE (RSS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:RAE
Last Name:KIZZIAR
Suffix:
Gender:F
Credentials:RSS
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:RAE
Other - Last Name:RAMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RSS
Mailing Address - Street 1:1500 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2827
Mailing Address - Country:US
Mailing Address - Phone:580-763-0931
Mailing Address - Fax:
Practice Address - Street 1:1500 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2827
Practice Address - Country:US
Practice Address - Phone:580-763-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator