Provider Demographics
NPI:1104591403
Name:TENEQUER, JESSICA PAIGE
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:PAIGE
Last Name:TENEQUER
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 1:3327 N COAL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-5719
Mailing Address - Country:US
Mailing Address - Phone:918-429-4743
Mailing Address - Fax:
Practice Address - Street 1:3327 N COAL CREEK RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-5719
Practice Address - Country:US
Practice Address - Phone:918-429-4743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator