NPI 1588716104

Grand Prairie Pediatric and Allergy Clinic

Organisation Preferred Provider Organization Warr Acres, OK

Practice location

Address: 7301 N Comanche Ave, Warr Acres, OK 73132-6646
Phone: (405) 721-8090
Fax: (405) 722-8529

Authorised official

Name: Kenneth C Jackson
Title: President
Phone: (405) 721-8090

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1588716104
Entity type: Organization
NPI issued: 16 Jan 2007
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.