Healthcare Provider Details

I. General information

NPI: 1104753003
Provider Name (Legal Business Name): JAMIE BARAJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NW FT SILL BLVD
LAWTON OK
73507
US

IV. Provider business mailing address

601 NW FORT SILL BLVD
LAWTON OK
73507-6601
US

V. Phone/Fax

Practice location:
  • Phone: 580-355-5170
  • Fax:
Mailing address:
  • Phone: 580-355-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number206929
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: