JACKIE ELLEN CHUCULATE - NPI 1063903029 - Peer Specialist in Vinita, OK

Q: What is Jackie Chuculate's NPI number?

The NPI number for Jackie Chuculate is 1063903029. It was assigned to this individual provider in the NPPES registry on May 25, 2018.

Q: What is Jackie Chuculate's specialty?

The primary specialty registered for this NPI is Peer Specialist with taxonomy code 175T00000X.

Q: When was this NPI record last updated?

The NPPES record for Jackie Chuculate was last updated on June 16, 2018. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Jackie Ellen Chuculate NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKIE ELLEN CHUCULATE (NPI 1063903029) is an individual peer specialist in Vinita, Oklahoma and active in the NPI registry since May 2018.

NPPES Registry Identity

NPI1063903029

Entity TypeIndividualFemale

Primary Taxonomy175T00000X

Provider Legal NameJACKIE ELLEN CHUCULATE

Location Address405 E EXCELSIOR AVEVinita, OK 74301-4226

Mailing Address405 E Excelsior AveVinita, OK 74301-4226 · (918) 256-6474 · Fax (918) 256-3628

Phone(918) 256-6474

Fax(918) 256-3628

Sole ProprietorNo

Enumeration DateMay 25, 2018

Last NPPES UpdateJune 16, 20182 updates tracked since enumeration

✔ NPI 1063903029 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

405 E EXCELSIOR AVE, Vinita, OK 74301

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANISSA MARIE MAYHEW

Case Manager/Care Coordinator