MEDICARE: JENNIFER GLENN APRN-CNP

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	RN60958318	WA
2	363L00000X	Nurse Practitioner	AP60958321	WA
3	363LF0000X	Family Nurse Practitioner	60961828	WA
4	363LF0000X	Family Nurse Practitioner	R0108302	OK
5	207Q00000X	Family Medicine Physician	R0108302	OK

General Provider Information

NPI Number	:	1043876071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GLENN APRN-CNP

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0156
Country	:	US
Telephone Number	:	405-347-9017
Fax Number	:

Provider Business Practice Location Address
First Line	:	20213 NE 23RD ST STE B1
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9144
Country	:	US
Telephone Number	:	405-347-9017
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/19/2026

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