Healthcare Provider Details

I. General information

NPI: 1194384990
Provider Name (Legal Business Name): JOURDAN HARKLESS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOURDAN A HARKLESS

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

700 NE 13TH ST # 38
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6651
  • Fax:
Mailing address:
  • Phone: 405-764-8066
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9344
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR-11621
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: