Provider Demographics
NPI:1437403938
Name:MAGNESS, JENNIFER JO (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:MAGNESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 S 103RD EAST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-2445
Mailing Address - Country:US
Mailing Address - Phone:918-921-9700
Mailing Address - Fax:918-292-8263
Practice Address - Street 1:3840 S 103RD EAST AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-2445
Practice Address - Country:US
Practice Address - Phone:918-921-9700
Practice Address - Fax:918-292-8263
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200587960AMedicaid