Provider Demographics
NPI:1851173009
Name:TIGER, JODIE LYNNE
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNNE
Last Name:TIGER
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 1:2914 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5158
Mailing Address - Country:US
Mailing Address - Phone:918-682-8407
Mailing Address - Fax:918-682-8760
Practice Address - Street 1:2914 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5158
Practice Address - Country:US
Practice Address - Phone:918-682-8407
Practice Address - Fax:918-682-8760
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist