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General NPI Number Information
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NPI Number | 1801753066
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Entity Type | Individual
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Provider Name | JENNIFER A DEJONGE
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 11205 N MAY AVE STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-6329
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Country | US
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Telephone | 405-249-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 5802 TARA LN
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City | GUTHRIE
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State | OK
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Zip | 73044-6769
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Country | US
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Telephone | 405-249-2380
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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