Provider Demographics
NPI:1194507319
Name:SUMMERS, JOANNA LYNN
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LYNN
Last Name:SUMMERS
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 1:9812 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8077
Mailing Address - Country:US
Mailing Address - Phone:405-623-6270
Mailing Address - Fax:
Practice Address - Street 1:9812 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8077
Practice Address - Country:US
Practice Address - Phone:405-623-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist