Healthcare Provider Details

I. General information

NPI: 1396060448
Provider Name (Legal Business Name): JENNIFER BROOKE STEWART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BROOKE WILLIAMS MD

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4913 W RENO AVE OKLAHOMA CITY INDIAN CLINIC
OKLAHOMA CITY OK
73127-6339
US

IV. Provider business mailing address

4913 W RENO AVE
OKLAHOMA CITY OK
73127-6339
US

V. Phone/Fax

Practice location:
  • Phone: 405-948-4900
  • Fax:
Mailing address:
  • Phone: 405-948-4900
  • Fax: 405-595-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29782
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: