Healthcare Provider Details

I. General information

NPI: 1629074992
Provider Name (Legal Business Name): TAMMY KAY JARVIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER BLVD
ADA OK
74820-3439
US

IV. Provider business mailing address

1925 WARRIOR WAY
ADA OK
74820-3491
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-3980
  • Fax: 580-421-6283
Mailing address:
  • Phone: 580-421-4570
  • Fax: 580-421-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3915
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: