Healthcare Provider Details

I. General information

NPI: 1780120212
Provider Name (Legal Business Name): JAZZ'LYNN DURANT FEMALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N DENVER AVE
TULSA OK
74103-1806
US

IV. Provider business mailing address

650 S PEORIA AVE
TULSA OK
74120-4429
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1200
  • Fax:
Mailing address:
  • Phone: 918-587-9471
  • Fax: 918-560-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: JAZZ'LYNN DURANT
Title or Position: CASE MANAGER
Credential:
Phone: 918-560-1335