Healthcare Provider Details

I. General information

NPI: 1134928096
Provider Name (Legal Business Name): ANNIKA MARIE JENNINGS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N MONTE VISTA ST
ADA OK
74820-7711
US

IV. Provider business mailing address

527 W 3RD ST
KONAWA OK
74849-1415
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-5111
  • Fax:
Mailing address:
  • Phone: 405-584-4078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number208595
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: