Healthcare Provider Details

I. General information

NPI: 1386525558
Provider Name (Legal Business Name): JASON FEATHERNGILL LMSW-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S EUCALYPTUS AVE STE 204
BROKEN ARROW OK
74012-5993
US

IV. Provider business mailing address

1615 S EUCALYPTUS AVE STE 204
BROKEN ARROW OK
74012-5993
US

V. Phone/Fax

Practice location:
  • Phone: 918-205-4148
  • Fax:
Mailing address:
  • Phone: 918-205-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22746-P
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: