Healthcare Provider Details

I. General information

NPI: 1669411500
Provider Name (Legal Business Name): PAMELA A. JARRETT, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 E 510 RD
CLAREMORE OK
74019-0326
US

IV. Provider business mailing address

PO BOX 1895
CLAREMORE OK
74018-1895
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-5488
  • Fax:
Mailing address:
  • Phone: 405-947-5557
  • Fax: 409-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3468
License Number StateOK

VIII. Authorized Official

Name: DR. PAMELA ANN JARRETT
Title or Position: OWNER PRESIDENT
Credential: DO
Phone: 918-342-5488