MEDICARE: JAYDEN SKILLENS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912852302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYDEN SKILLENS

Provider Business Mailing Address
First Line	:	7645 E 63RD ST STE 102
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-1249
Country	:	US
Telephone Number	:	918-932-8774
Fax Number	:	844-881-4140

Provider Business Practice Location Address
First Line	:	7645 E 63RD ST STE 102
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-1249
Country	:	US
Telephone Number	:	918-932-8774
Fax Number	:	844-881-4140

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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