Provider Demographics
NPI:1669641171
Name:MEDEIROS, JULIA JORDAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:JORDAN
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JULIA
Other - Middle Name:LEA
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-1278
Mailing Address - Country:US
Mailing Address - Phone:918-647-0670
Mailing Address - Fax:918-647-0460
Practice Address - Street 1:101 SMITH AVE
Practice Address - Street 2:STE 2
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-2613
Practice Address - Country:US
Practice Address - Phone:918-647-0670
Practice Address - Fax:918-647-0460
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0035513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731348230OtherSTEVEN P. MEDEIROS, DO, INC
OK200187110AMedicaid