Provider Demographics
NPI:1972768299
Name:SKEANS, JENIFER RENEE (CSFA)
Entity type:Individual
Prefix:MRS
First Name:JENIFER
Middle Name:RENEE
Last Name:SKEANS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:CLAY SKEANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:6515 S. 250TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014
Mailing Address - Country:US
Mailing Address - Phone:918-289-8422
Mailing Address - Fax:918-286-0077
Practice Address - Street 1:6515 S. 250TH EAST AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014
Practice Address - Country:US
Practice Address - Phone:918-289-8422
Practice Address - Fax:918-286-0077
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171496246ZS0410X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist