Provider Demographics
NPI:1770643769
Name:EPPERLEY, JANE (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:EPPERLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:EPPERLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:6853 S CANTON
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3405
Mailing Address - Country:US
Mailing Address - Phone:918-496-8050
Mailing Address - Fax:918-496-9597
Practice Address - Street 1:6853 S CANTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3405
Practice Address - Country:US
Practice Address - Phone:918-496-8050
Practice Address - Fax:918-496-9597
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK272103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R1170Medicare UPIN