Provider Demographics
NPI:1790703726
Name:ABSHERE, JODI KAY (MED)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:KAY
Last Name:ABSHERE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6121
Mailing Address - Country:US
Mailing Address - Phone:580-678-7759
Mailing Address - Fax:
Practice Address - Street 1:1105 S. MAIN
Practice Address - Street 2:SUITE #1
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:918-712-0859
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional