Provider Demographics
NPI:1023088176
Name:NEEL, JACKIE LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:LYNN
Last Name:NEEL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 31
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-502-5052
Mailing Address - Fax:918-502-5060
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-502-5052
Practice Address - Fax:918-502-5060
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK21082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100028800BMedicaid
39745OtherCIGNA BEHAVIORAL HEALTH
4306557OtherAETNA BEHAVIORAL HEALTH
OK100028800BMedicaid
OK245510603Medicare PIN