Provider Demographics
NPI:1154670677
Name:TALBERT, JENNIFER DIANE (CPO)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DIANE
Last Name:TALBERT
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1761
Mailing Address - Country:US
Mailing Address - Phone:405-525-4000
Mailing Address - Fax:405-530-3670
Practice Address - Street 1:4207 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1761
Practice Address - Country:US
Practice Address - Phone:405-525-4000
Practice Address - Fax:405-530-3670
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLO50222Z00000X
OKLP37224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO03055OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS & PROSTHETICS