Healthcare Provider Details

I. General information

NPI: 1407223605
Provider Name (Legal Business Name): JULIE JARVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S KERR BLVD
SALLISAW OK
74955-7240
US

IV. Provider business mailing address

PO BOX 179
STIGLER OK
74462-0179
US

V. Phone/Fax

Practice location:
  • Phone: 918-790-2653
  • Fax: 918-790-2763
Mailing address:
  • Phone: 918-967-3368
  • Fax: 918-967-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR85644
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85644
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: