Provider Demographics
NPI:1912476383
Name:SKINNER, TEENA MARIE
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:MARIE
Last Name:SKINNER
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 1:505 N 14TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5000
Mailing Address - Country:US
Mailing Address - Phone:580-336-5200
Mailing Address - Fax:580-336-5201
Practice Address - Street 1:505 N 14TH ST STE A
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5000
Practice Address - Country:US
Practice Address - Phone:580-336-5200
Practice Address - Fax:580-336-5201
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator