Provider Demographics
NPI:1861835142
Name:WALSH, JENNY SCOVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:SCOVILLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1121 NEO LOOP
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6046
Mailing Address - Country:US
Mailing Address - Phone:918-786-8448
Mailing Address - Fax:918-786-9502
Practice Address - Street 1:1121 NEO LOOP
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6046
Practice Address - Country:US
Practice Address - Phone:918-786-8448
Practice Address - Fax:918-786-9502
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2022-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK32095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine