Healthcare Provider Details

I. General information

NPI: 1124536388
Provider Name (Legal Business Name): JACQUELINE ANN YARBROUGH FNP- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13509 N MERIDIAN AVE
OKLAHOMA CITY OK
73120-8397
US

IV. Provider business mailing address

8900 SILVER HILL DR
OKLAHOMA CITY OK
73132-3316
US

V. Phone/Fax

Practice location:
  • Phone: 405-937-7422
  • Fax: 405-848-3591
Mailing address:
  • Phone: 405-557-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number77656
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0077656
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: