Healthcare Provider Details

I. General information

NPI: 1871401448
Provider Name (Legal Business Name): JADYN FLORES FLORES MONTGOMERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 HARDCASTLE BLVD
PURCELL OK
73080-8233
US

IV. Provider business mailing address

1438 HARDCASTLE BLVD
PURCELL OK
73080-8233
US

V. Phone/Fax

Practice location:
  • Phone: 405-527-4700
  • Fax: 405-527-1945
Mailing address:
  • Phone: 405-527-4700
  • Fax: 405-527-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number133769
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: