MEDICARE: JENNIFER REBECCA DODSON P.A.

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	363A00000X	Physician Assistant	1202	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	:	1467450510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER REBECCA DODSON P.A.

Provider Business Mailing Address
First Line	:	105 S BRYANT AVE STE 105
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-6330
Country	:	US
Telephone Number	:	405-359-5403
Fax Number	:	405-359-5112

Provider Business Practice Location Address
First Line	:	9800 BROADWAY EXT STE 201
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-6304
Country	:	US
Telephone Number	:	405-424-5426
Fax Number	:	405-424-5431

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/24/2026

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