Healthcare Provider Details

I. General information

NPI: 1437717196
Provider Name (Legal Business Name): JENNA LYN TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST # 3520
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

700 NE 13TH ST # 3520
OKLAHOMA CITY OK
73104-5004
US

V. Phone/Fax

Practice location:
  • Phone: 405-613-9704
  • Fax:
Mailing address:
  • Phone: 405-613-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number115776
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number115776
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: