Provider Demographics
NPI:1134247083
Name:PATTERSON JENKINS, ROBIN GALE (BA, CM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:GALE
Last Name:PATTERSON JENKINS
Suffix:
Gender:F
Credentials:BA, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37512 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873-5153
Mailing Address - Country:US
Mailing Address - Phone:405-598-9272
Mailing Address - Fax:
Practice Address - Street 1:101 N UNION AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-7067
Practice Address - Country:US
Practice Address - Phone:405-275-7100
Practice Address - Fax:405-275-7105
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051970CMedicaid