Healthcare Provider Details

I. General information

NPI: 1750595161
Provider Name (Legal Business Name): JILL LYNN NOBLES-BOTKIN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL LYNN NOBLES

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 10TH ST
OKLAHOMA CITY OK
73117-1207
US

IV. Provider business mailing address

6204 GREENWOOD LN
OKLAHOMA CITY OK
73132-5629
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4476
  • Fax: 405-271-9202
Mailing address:
  • Phone: 405-470-1562
  • Fax: 405-947-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR0047701
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: