Provider Demographics
NPI:1669730289
Name:JENNINGS, VIRGIL L JR
Entity type:Individual
Prefix:MR
First Name:VIRGIL
Middle Name:L
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 STRATFORD DR APT 157
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8475
Mailing Address - Country:US
Mailing Address - Phone:405-254-3867
Mailing Address - Fax:
Practice Address - Street 1:12821 STRATFORD DR APT 157
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8475
Practice Address - Country:US
Practice Address - Phone:405-254-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator