MEDICARE: JENNY LEA GUTHRIE APRN CNP

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	363L00000X	Nurse Practitioner	R0064318	OK

General Provider Information

NPI Number	:	1881662666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LEA GUTHRIE APRN CNP

Provider Business Mailing Address
First Line	:	9101 S TOLEDO AVE
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74137-2719
Country	:	US
Telephone Number	:	918-260-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 S TOLEDO AVE
Second Line	:	STE B
City	:	TULSA
State	:	OK
Zip	:	74137-2719
Country	:	US
Telephone Number	:	918-260-9322
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	06/04/2013

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