Provider Demographics
NPI:1508672056
Name:GARR, JERICHO
Entity type:Individual
Prefix:
First Name:JERICHO
Middle Name:
Last Name:GARR
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 1:1719 HIGHWAY 82 N
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:OK
Mailing Address - Zip Code:74365-2531
Mailing Address - Country:US
Mailing Address - Phone:918-232-1210
Mailing Address - Fax:
Practice Address - Street 1:621 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-4215
Practice Address - Country:US
Practice Address - Phone:918-696-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator