Provider Demographics
NPI:1659816791
Name:KLUFA, JENNA-LYN (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNA-LYN
Middle Name:
Last Name:KLUFA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-6025
Mailing Address - Country:US
Mailing Address - Phone:580-304-3093
Mailing Address - Fax:
Practice Address - Street 1:600 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3558
Practice Address - Country:US
Practice Address - Phone:580-628-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF1216338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily