Provider Demographics
NPI:1891057444
Name:ALFORD, JENELLIS
Entity Type:Individual
Prefix:MISS
First Name:JENELLIS
Middle Name:
Last Name:ALFORD
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 1:125 NW 20TH ST
Mailing Address - Street 2:APT # 2
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-4424
Mailing Address - Country:US
Mailing Address - Phone:405-429-5292
Mailing Address - Fax:
Practice Address - Street 1:125 NW 20TH ST
Practice Address - Street 2:APT # 2
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-4424
Practice Address - Country:US
Practice Address - Phone:405-429-5292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator