Healthcare Provider Details

I. General information

NPI: 1013020643
Provider Name (Legal Business Name): JANE M HARMON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S CENTRAL AVE STE 2
IDABEL OK
74745-4848
US

IV. Provider business mailing address

305 DOGWOOD CT
BROKEN BOW OK
74728-6118
US

V. Phone/Fax

Practice location:
  • Phone: 580-236-9886
  • Fax:
Mailing address:
  • Phone: 580-584-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR0105058
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number227609
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number227609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: