| Headache Specialists Of Oklahoma Pllc | |
|
1516 S Yorktown Pl Tulsa OK 74104-4918 | |
| (918) 922-8612 | |
| (539) 867-2151 |
| Full Name | Headache Specialists Of Oklahoma Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1516 S Yorktown Pl, Tulsa, Oklahoma |
| Authorized Official Name and Position | Jaclyn R Duvall (PHYSICIAN) |
| Authorized Official Contact | 9186973138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Headache Specialists Of Oklahoma Pllc 1516 S Yorktown Pl Tulsa OK 74104-4918 Ph: (918) 922-8612 | Headache Specialists Of Oklahoma Pllc 1516 S Yorktown Pl Tulsa OK 74104-4918 Ph: (918) 922-8612 |
| NPI Number | 1417685538 |
|---|---|
| Provider Enumeration Date | 08/09/2022 |
| Last Update Date | 09/03/2022 |
| Certification Date | 09/03/2022 |
| Medicare PECOS PAC ID | 1355726928 |
|---|---|
| Medicare Enrollment ID | O20220917000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417685538 | NPI | - | NPPES |
| 200444390B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Jaclyn Diane Duvall |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1740541473 PECOS PAC ID: 5496042533 Enrollment ID: I20160917000010 |
| Provider Name | Sarah Renea Gilbert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417453853 PECOS PAC ID: 2062767247 Enrollment ID: I20180611002464 |
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