Provider Demographics
NPI:1346240199
Name:HARGRAVE, JERI L (ARNP)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:L
Last Name:HARGRAVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-606-2260
Mailing Address - Fax:405-606-2241
Practice Address - Street 1:117 PARK AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-9030
Practice Address - Country:US
Practice Address - Phone:405-606-2260
Practice Address - Fax:405-606-2241
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0037216363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200028310AMedicaid
OK200028310AMedicaid
OKQ13684Medicare UPIN
Q13684Medicare UPIN