Healthcare Provider Details

I. General information

NPI: 1861469363
Provider Name (Legal Business Name): JODI D. MCLAIN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 S YALE AVE SUITE 200
TULSA OK
74137-6078
US

IV. Provider business mailing address

10011 S YALE AVE SUITE 200
TULSA OK
74137-6078
US

V. Phone/Fax

Practice location:
  • Phone: 918-493-1114
  • Fax: 918-392-0128
Mailing address:
  • Phone: 918-493-1114
  • Fax: 918-392-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberROO72480
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: