Healthcare Provider Details

I. General information

NPI: 1467880047
Provider Name (Legal Business Name): JENNIFER LEA PIPPIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 SW 89TH ST
OKLAHOMA CITY OK
73159-6943
US

IV. Provider business mailing address

1404 SW 71ST ST
OKLAHOMA CITY OK
73159-3406
US

V. Phone/Fax

Practice location:
  • Phone: 405-703-8424
  • Fax:
Mailing address:
  • Phone: 405-371-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number585723
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: