Provider Demographics
NPI:1609141787
Name:FATON, JILLIAN BETH (CPNP, APRN)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:BETH
Last Name:FATON
Suffix:
Gender:F
Credentials:CPNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 W FARGO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-0829
Mailing Address - Country:US
Mailing Address - Phone:918-694-1382
Mailing Address - Fax:
Practice Address - Street 1:707 S OSAGE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-4943
Practice Address - Country:US
Practice Address - Phone:918-876-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89462363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200436700AMedicaid