Provider Demographics
NPI:1124415815
Name:BREEDLOVE, JAMIE L (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S UTICA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4022
Mailing Address - Country:US
Mailing Address - Phone:918-579-3130
Mailing Address - Fax:918-579-3139
Practice Address - Street 1:1145 S UTICA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4022
Practice Address - Country:US
Practice Address - Phone:918-579-3130
Practice Address - Fax:918-579-3139
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health