Provider Demographics
NPI:1386994473
Name:FARMER, JENNIFER KELLILYN (BHRS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLILYN
Last Name:FARMER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9803 E 84TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2355
Mailing Address - Country:US
Mailing Address - Phone:918-906-8614
Mailing Address - Fax:
Practice Address - Street 1:9803 E 84TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2355
Practice Address - Country:US
Practice Address - Phone:918-906-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst