Basic Information
| Provider Information | |||||||||
| NPI: | 1346793924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUMBS | ||||||||
| FirstName: | JERMEKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 S LEWIS AVE | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741710001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523010127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11740 E 21ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741291820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184379495 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2016 | ||||||||
| LastUpdateDate: | 07/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | OK | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.