Healthcare Provider Details

I. General information

NPI: 1477478550
Provider Name (Legal Business Name): JADE MARIE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S TREATY RD
MIAMI OK
74354-5327
US

IV. Provider business mailing address

9510 S 580 RD
MIAMI OK
74354-3520
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-1511
  • Fax:
Mailing address:
  • Phone: 918-961-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: