MEDICARE: MRS. PRIYA JAISON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	91975	OK

General Provider Information

NPI Number	:	1023592847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRIYA JAISON FNP-C

Provider Business Mailing Address
First Line	:	1913 BREAKERS LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7016
Country	:	US
Telephone Number	:	405-413-2505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 BREAKERS LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73128-7016
Country	:	US
Telephone Number	:	405-413-2505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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