MEDICARE: JONATHAN WILLSON

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	363L00000X	Nurse Practitioner	225851	OK
2	163W00000X	Registered Nurse	R0133031	OK

General Provider Information

NPI Number	:	1215826037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WILLSON

Provider Business Mailing Address
First Line	:	109 W COMMERCIAL ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4012
Country	:	US
Telephone Number	:	918-887-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W COMMERCIAL ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4012
Country	:	US
Telephone Number	:	918-887-8300
Fax Number	:

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

Provider Enumeration Date	:	06/30/2025
Last Update Date	:	12/18/2025

Similar Medicare Providers

1992263453 — ASHTON DANIELLE PETERSON
Practice Location Address:

109 W COMMERCIAL ST
BROKEN ARROW, OK
74012-4012

Practice Phone: 918-887-8300
Practice Fax: 833-941-2348

1851062517 — PETERSON WELLNESS PRIMARY CARE AND PEDIATRICS, PLLC
Practice Location Address:

109 W COMMERCIAL ST
BROKEN ARROW, OK
74012-4012

Practice Phone: 918-724-3952
Practice Fax:

1063238665 — AMANDA SKVORTSOV APRN
Practice Location Address:

109 W COMMERCIAL ST
BROKEN ARROW, OK
74012-4012

Practice Phone: 918-887-8300
Practice Fax:

1700740651 — MARCUS HOPKINS
Practice Location Address:

721 W QUEENS ST
BROKEN ARROW, OK
74012-1767

Practice Phone: 539-367-1534
Practice Fax:

1790640431 — MADISON BROOKE FROHRIP
Practice Location Address:

3113 S MAPLE AVE
BROKEN ARROW, OK
74012-7748

Practice Phone: 918-994-2764
Practice Fax:

1063801660 — JOHN CLAY BOWEN DO
Practice Location Address:

2950 S ELM PL STE 120
BROKEN ARROW, OK
74012-7816

Practice Phone: 918-451-5191
Practice Fax: 918-449-4653

Directions to “ JONATHAN WILLSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.