Healthcare Provider Details

I. General information

NPI: 1801701537
Provider Name (Legal Business Name): JENNIFER GATES CBCS, CHW, PRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NE 1ST ST
PRYOR OK
74361-2403
US

IV. Provider business mailing address

3660 W 530 APT 309
PRYOR OK
74361-8172
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-4224
  • Fax:
Mailing address:
  • Phone: 918-825-4224
  • Fax: 918-244-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number202674
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: