Healthcare Provider Details

I. General information

NPI: 1154127801
Provider Name (Legal Business Name): JAIME WOOD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 S YALE AVE STE 200
TULSA OK
74137-6063
US

IV. Provider business mailing address

10011 S YALE AVE STE 200
TULSA OK
74137-6063
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-1114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222110
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: