Healthcare Provider Details

I. General information

NPI: 1013247378
Provider Name (Legal Business Name): JENNIFER LEIGH FLECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2010
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 W ROCK CREEK RD SUITE 100
NORMAN OK
73072-2202
US

IV. Provider business mailing address

3650 W ROCK CREEK RD SUITE 100
NORMAN OK
73072-2202
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-3418
  • Fax: 405-701-3451
Mailing address:
  • Phone: 405-701-3418
  • Fax: 405-701-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number83338
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: