Provider Demographics
NPI:1154107589
Name:TONEY, JENNIFER ELAINE (MED)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELAINE
Last Name:TONEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:PANAMA
Mailing Address - State:OK
Mailing Address - Zip Code:74951-0574
Mailing Address - Country:US
Mailing Address - Phone:479-462-7508
Mailing Address - Fax:
Practice Address - Street 1:401 HIGH SCHOOL DR.
Practice Address - Street 2:
Practice Address - City:PANAMA
Practice Address - State:OK
Practice Address - Zip Code:74951
Practice Address - Country:US
Practice Address - Phone:918-963-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool