Provider Demographics
NPI:1174048169
Name:MCCRARY, JESSICA RHIANNON
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RHIANNON
Last Name:MCCRARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 NW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-4107
Mailing Address - Country:US
Mailing Address - Phone:405-269-8968
Mailing Address - Fax:
Practice Address - Street 1:5929 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-4107
Practice Address - Country:US
Practice Address - Phone:405-269-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator