Healthcare Provider Details

I. General information

NPI: 1891221602
Provider Name (Legal Business Name): JENNIFER ALBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11610 N 137TH EAST AVE
COLLINSVILLE OK
74021-3601
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 918-928-4180
  • Fax: 918-928-4185
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110591
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: