Provider Demographics
NPI:1043876071
Name:MCCAMMOND, JENNIFER (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCCAMMOND
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0156
Mailing Address - Country:US
Mailing Address - Phone:405-347-9017
Mailing Address - Fax:
Practice Address - Street 1:20213 NE 23RD ST STE B1
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045-9144
Practice Address - Country:US
Practice Address - Phone:405-347-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60958318363LF0000X
OKR0108302363LF0000X, 207Q00000X
WA60961828363LF0000X
WAAP60958321363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner