Provider Demographics
NPI:1033799275
Name:RUSSELL, JARROD DAUN SR (CNA,)
Entity Type:Individual
Prefix:MR
First Name:JARROD
Middle Name:DAUN
Last Name:RUSSELL
Suffix:SR
Gender:M
Credentials:CNA,
Other - Prefix:MR
Other - First Name:JARROD
Other - Middle Name:DAUN
Other - Last Name:RUSSELL
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:ACMA,
Mailing Address - Street 1:1746 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-1439
Mailing Address - Country:US
Mailing Address - Phone:405-900-3905
Mailing Address - Fax:
Practice Address - Street 1:1746 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-1439
Practice Address - Country:US
Practice Address - Phone:405-900-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37V9751704193747P1801X, 385H00000X, 376K00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care