MEDICARE: JENNIFER JO MAGNESS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	62199	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437403938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JO MAGNESS NP

Provider Business Mailing Address
First Line	:	3840 S 103RD EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-2445
Country	:	US
Telephone Number	:	918-921-9700
Fax Number	:	918-292-8263

Provider Business Practice Location Address
First Line	:	3840 S 103RD EAST AVE STE 100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-2445
Country	:	US
Telephone Number	:	918-921-9700
Fax Number	:	918-292-8263

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	01/14/2021

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Directions to “ JENNIFER JO MAGNESS NP” Practice Location

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