Healthcare Provider Details

I. General information

NPI: 1942224100
Provider Name (Legal Business Name): JENNIFER A MCREYNOLDS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13921 N MERIDIAN AVE STE 100
OKLAHOMA CITY OK
73134-1106
US

IV. Provider business mailing address

3435 NW 56TH ST SUITE 412
OKLAHOMA CITY OK
73112-4448
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-9600
  • Fax: 405-752-9650
Mailing address:
  • Phone: 405-945-4325
  • Fax: 405-945-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1415
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: