Provider Demographics
NPI:1912464124
Name:TYNER, JHAVONNE
Entity type:Individual
Prefix:
First Name:JHAVONNE
Middle Name:
Last Name:TYNER
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 1:1901 BREAKERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128-7014
Mailing Address - Country:US
Mailing Address - Phone:405-532-0948
Mailing Address - Fax:
Practice Address - Street 1:3035 NW 63RD ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3606
Practice Address - Country:US
Practice Address - Phone:405-242-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-23
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator