Provider Demographics
NPI:1558932483
Name:AMATO, JENNIFER (APRN-CNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AMATO
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 S SUNNYLANE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3031
Mailing Address - Country:US
Mailing Address - Phone:405-369-3329
Mailing Address - Fax:414-238-9455
Practice Address - Street 1:1491 S SUNNYLANE RD STE 104
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3031
Practice Address - Country:US
Practice Address - Phone:405-369-3329
Practice Address - Fax:414-238-9455
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK204005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health