Healthcare Provider Details

I. General information

NPI: 1104765288
Provider Name (Legal Business Name): LAKEN ELIZABETH JANNEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9907
US

IV. Provider business mailing address

18076 STATE HIGHWAY A
MONTICELLO MO
63457-2161
US

V. Phone/Fax

Practice location:
  • Phone: 918-586-4500
  • Fax:
Mailing address:
  • Phone: 573-822-7965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: