Healthcare Provider Details

I. General information

NPI: 1558993691
Provider Name (Legal Business Name): JENNIFER A HENDRIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S DEWEY AVE STE 108
BARTLESVILLE OK
74003-3525
US

IV. Provider business mailing address

27871 N 3950 RD
OCHELATA OK
74051-2005
US

V. Phone/Fax

Practice location:
  • Phone: 918-336-0810
  • Fax: 918-336-0836
Mailing address:
  • Phone: 918-534-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: