Provider Demographics
NPI:1700373396
Name:JARVIS, MEAGHAN NICOLE
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:NICOLE
Last Name:JARVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-3206
Mailing Address - Country:US
Mailing Address - Phone:580-744-9382
Mailing Address - Fax:
Practice Address - Street 1:925 N ELM ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-3206
Practice Address - Country:US
Practice Address - Phone:580-744-9382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator