Healthcare Provider Details

I. General information

NPI: 1770123655
Provider Name (Legal Business Name): JENNIFER KATHERINE YEAMAN MSN, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 N MAY AVE
OKLAHOMA CITY OK
73120-4417
US

IV. Provider business mailing address

9100 N MAY AVE
OKLAHOMA CITY OK
73120-4417
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-4496
  • Fax: 405-840-4295
Mailing address:
  • Phone: 405-840-4496
  • Fax: 405-840-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number112357
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number112357
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112357
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: