JACKIE RAY WILSON
NPI 1831835107
Peer Specialist in Stroud, OK
Active since May 10, 2022
About Jackie Ray Wilson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACKIE RAY WILSON (NPI 1831835107) is an individual peer specialist in Stroud, Oklahoma and active in the NPI registry since May 2022.
NPPES Registry Identity
NPI1831835107
Entity TypeIndividualMale
Primary Taxonomy175T00000X
Provider Legal NameJACKIE RAY WILSON
Location Address119 W 2ND STStroud, OK 74079-4011
Mailing Address6333 E Skelly DrTulsa, OK 74135-6106 · (918) 664-4224
Phone(405) 328-1549
Sole ProprietorNo
Enumeration DateMay 10, 2022
Last NPPES UpdateDecember 16, 20222 updates tracked since enumeration
NPPES CertifiedDecember 16, 2022
✔ NPI 1831835107 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.
119 W 2ND ST, Stroud, OK 74079
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1831835107, enumerated as an "individual" on May 10, 2022.
The provider is located at 119 W 2ND ST STROUD, OK 74079 and the phone number is (405) 328-1549.
Peer Specialist with taxonomy code 175T00000X.
