Healthcare Provider Details

I. General information

NPI: 1669398145
Provider Name (Legal Business Name): JAMIE MICHELL MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NEO LOOP
GROVE OK
74344-6046
US

IV. Provider business mailing address

2305 NUBBIN RIDGE RD
ROYAL AR
71968-8003
US

V. Phone/Fax

Practice location:
  • Phone: 877-783-4441
  • Fax:
Mailing address:
  • Phone: 405-323-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number237563
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: