Healthcare Provider Details

I. General information

NPI: 1912092941
Provider Name (Legal Business Name): JORETTA WARREN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 SOUTH RANKIN
EDMOND OK
73013
US

IV. Provider business mailing address

4350 WILL ROGERS PKWY SUITE 600
OKLAHOMA CITY OK
73108-1826
US

V. Phone/Fax

Practice location:
  • Phone: 405-941-1433
  • Fax:
Mailing address:
  • Phone: 405-943-1144
  • Fax: 405-943-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR0037176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: