Healthcare Provider Details

I. General information

NPI: 1053193144
Provider Name (Legal Business Name): JENNIFER MORELAND DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 ROSE TREE LN
ENID OK
73703-3533
US

IV. Provider business mailing address

419 ROSE TREE LN
ENID OK
73703-3533
US

V. Phone/Fax

Practice location:
  • Phone: 405-227-3495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number229731
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: