Provider Demographics
NPI:1003531211
Name:TALLBEAR, JEANNIE ROSE (APRN-CNP, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:ROSE
Last Name:TALLBEAR
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 S SUNNYLANE RD
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3037
Mailing Address - Country:US
Mailing Address - Phone:405-437-2240
Mailing Address - Fax:661-231-3153
Practice Address - Street 1:1491 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3037
Practice Address - Country:US
Practice Address - Phone:405-433-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK210525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health