Healthcare Provider Details

I. General information

NPI: 1225954902
Provider Name (Legal Business Name): JOHNATHAN GABRIEL RODERY DNAP-CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 HEALTHPLEX PKWY
NORMAN OK
73072-9749
US

IV. Provider business mailing address

9004 NW 142ND ST
YUKON OK
73099-1355
US

V. Phone/Fax

Practice location:
  • Phone: 405-515-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number229773
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: