Provider Demographics
NPI:1114775483
Name:NTEERE, JACQUELINE GATWIRI
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GATWIRI
Last Name:NTEERE
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 1:3501 MEARES DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1475
Mailing Address - Country:US
Mailing Address - Phone:580-699-6834
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST STE 650
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7915
Practice Address - Country:US
Practice Address - Phone:405-607-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217264363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health