Healthcare Provider Details

I. General information

NPI: 1023660578
Provider Name (Legal Business Name): JAIME L MCMINN APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME L LIPHAM

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 CROSSROADS BLVD STE 100
NORMAN OK
73072-3359
US

IV. Provider business mailing address

PO BOX 722791
NORMAN OK
73070-9118
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-2715
  • Fax: 405-310-6720
Mailing address:
  • Phone: 405-310-3102
  • Fax: 405-310-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82934
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: