Provider Demographics
NPI:1285321604
Name:BARNETT, JEREMY TYRELL
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:TYRELL
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 LISA LN
Mailing Address - Street 2:
Mailing Address - City:WAUKOMIS
Mailing Address - State:OK
Mailing Address - Zip Code:73773-1011
Mailing Address - Country:US
Mailing Address - Phone:580-377-9320
Mailing Address - Fax:
Practice Address - Street 1:511 LISA LN
Practice Address - Street 2:
Practice Address - City:WAUKOMIS
Practice Address - State:OK
Practice Address - Zip Code:73773-1011
Practice Address - Country:US
Practice Address - Phone:580-377-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator