Provider Demographics
NPI:1649582966
Name:BAUM, JAIME MOYNIHAN (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:MOYNIHAN
Last Name:BAUM
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:MICHELLE
Other - Last Name:MOYNIHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:4205 MCAULEY BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9309
Mailing Address - Country:US
Mailing Address - Phone:405-749-4247
Mailing Address - Fax:405-749-4249
Practice Address - Street 1:4205 MCAULEY BLVD STE 375
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120
Practice Address - Country:US
Practice Address - Phone:405-749-4247
Practice Address - Fax:405-749-4249
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0092811363L00000X
VA0024168846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200481470 AMedicaid