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General NPI Number Information
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NPI Number | 1619622230
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Entity Type | Organization
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Legal Business Name | JNKYNP, LLC.
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 4905 NW 155TH ST
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City | EDMOND
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State | OK
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Zip | 73013-9666
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Country | US
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Telephone | 405-401-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 12220 N. MACARTHUR BLVD. STE. F #160
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162
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Country | US
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Telephone | 405-562-3701
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Fax | 405-562-6257
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. JENNIFER YEAMAN
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Credential | MSN, APRN, AGNP-C
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Telephone | 405-562-3701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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