Healthcare Provider Details

I. General information

NPI: 1467364026
Provider Name (Legal Business Name): JAMIE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S BROADWAY ST
GROVE OK
74344-3310
US

IV. Provider business mailing address

310 S BROADWAY ST
GROVE OK
74344-3310
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-3003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number220760
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: