Provider Demographics
NPI:1700946738
Name:VANDIVER, JAMEY LYNN (MS)
Entity type:Individual
Prefix:MRS
First Name:JAMEY
Middle Name:LYNN
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S DAVID LN
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-7711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S. 142TH ST. W.
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:OK
Practice Address - Zip Code:74463-0316
Practice Address - Country:US
Practice Address - Phone:918-682-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health