Provider Demographics
NPI:1639105000
Name:BAUGHMAN, JENAE C (ARNP)
Entity Type:Individual
Prefix:MR
First Name:JENAE
Middle Name:C
Last Name:BAUGHMAN
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 1:3 PECAN RDG
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-9520
Mailing Address - Country:US
Mailing Address - Phone:405-273-4970
Mailing Address - Fax:
Practice Address - Street 1:2307 S GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9007
Practice Address - Country:US
Practice Address - Phone:405-273-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700540AMedicaid
OK1764378Medicaid
OK371825Medicare ID - Type UnspecifiedCLINIC #
OK241431715Medicare PIN
OKQ28078Medicare UPIN