MR. EDWARD CLYDE SKIDMORE JR. (NPI# 1992081137) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992081137 |
| Entity Type | Individual |
| Full Name | MR. EDWARD CLYDE SKIDMORE JR. |
| Credential | R.S.S. |
| Practice Address |
417 Cottonwood St Ardmore OK 73401-1732 |
| Mailing Address |
Po Box 1327 Ardmore OK 73402-1327 |
| Practice Telephone | 5803198402 |
| Mailing Telephone | 5803198402 |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2011-11-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 101YP1600X |
Counselor Specialization: Pastoral |
Behavioral Health & Social Service Providers |
| Street Address |
417 COTTONWOOD ST |
| City | ARDMORE |
| State | OK |
| Zip Code | 73401-1732 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497391452 | Abbie Deeann Mclemore | Nurse Practitioner | 915 10th Ave, Ardmore, OK 73401 | 2019-11-25 |
| 1790349991 | Shirley Denise Brown | Licensed Psychiatric Technician | 1219 Kst N.w, 1219 Kst N.w, Ardmore, OK 73401 | 2019-04-24 |
| 1427512359 | Billy Joe Oshields | Case Manager/Care Coordinator | 6862 State Hwy 199 Ardmore Oklahoma, 6862 State Hwy 199, Ardmore, OK 73401 | 2019-01-24 |
| 1174007595 | Tawnya Dawn Peery | Nurse Practitioner | 1108 W. Walnut Drive, Ardmore, OK 73401 | 2018-09-21 |
| 1679055016 | Teresa Marie Hernandez | Behavior Technician | 1219 K St. Nw, Ardmore, OK 73401 | 2018-09-01 |
| 1063991974 | Sawyer Rae Shamburger | Occupational Therapy Assistant | 208 North Praire St, Pilot Point, TX 73401 | 2018-08-10 |
| 1417473521 | Chelsye Bacon | Peer Specialist | 905 Holiday Drive, Ardmore, OK 73401 | 2017-08-21 |
| 1003279746 | Jeni Presley | Marriage & Family Therapist | Outpatient Services-ardmore; 2510 Chickasaw Dr., Strong Family Development;, Ardmore, OK 73401 | 2016-03-31 |
| 1982080909 | Alison Hill | Pharmacist | 1111 N. Commerce, Ardmore, OK 73401 | 2015-07-31 |
| 1316346547 | Olivia Larae Carrell | Counselor | 15 Monroe Street Ne, Ardmore, OK 73401 | 2014-08-13 |
| Find all providers in zip 73401 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801347067 | Laura Salciunas | Counselor | 63 W Lancaster Ave Ste 2, Ardmore, PA 19003-1413 | 2016-10-21 |
| 1386195287 | Billy Wood | Counselor | 315 4th Ave Nw, Ardmore, OK 73401-6112 | 2016-10-17 |
| 1972054799 | Latoria Perry | Counselor | 117 W Broadway St # 301, Ardmore, OK 73401-6226 | 2016-10-17 |
| 1417244278 | Billy Roy Clark | Counselor | 117 W Broadway St Ste 301, Ardmore, OK 73401-6226 | 2011-06-30 |
| 1801023023 | Tanya Revels | Counselor | 312 Barbara St, Ardmore, OK 73401-9716 | 2009-06-15 |
| 1023243862 | Sherri N. Miller | Counselor | 1405 4th Ave Nw # 75, Ardmore, OK 73401-2708 | 2009-05-22 |
| 1881830057 | Tammy Sue Morgan | Counselor | 10 W Main St Ste 209, Ardmore, OK 73401-6515 | 2008-12-18 |
| 1710136015 | Lynette Yvonne Spradling | Counselor | 2530 S Commerce Street, Ardmore, OK 73402 | 2008-09-11 |
| 1487849113 | Judith Annette Caton | Counselor | 2 Broadlawn, Ardmore, OK 73401 | 2007-09-06 |
| 1922298975 | Jackie L Williams | Counselor | 2530 South Commerce, Ardmore, OK 73401 | 2007-07-26 |
| Find all providers in ARDMORE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.