Healthcare Provider Details

I. General information

NPI: 1831915461
Provider Name (Legal Business Name): JAIME POPP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 W MEMORIAL RD
OKLAHOMA CITY OK
73120-9320
US

IV. Provider business mailing address

4120 W MEMORIAL RD
OKLAHOMA CITY OK
73120-9320
US

V. Phone/Fax

Practice location:
  • Phone: 405-936-5996
  • Fax:
Mailing address:
  • Phone: 405-936-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberR0089362
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: