Healthcare Provider Details

I. General information

NPI: 1184014722
Provider Name (Legal Business Name): JENNY LAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE STE 280
OKLAHOMA CITY OK
73112-5555
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3919
  • Fax: 405-713-4656
Mailing address:
  • Phone: 405-949-3919
  • Fax: 405-713-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number80925
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: