Provider Demographics
NPI:1679013809
Name:ERNST, JAMIE MARIE (FNP-APN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:ERNST
Suffix:
Gender:F
Credentials:FNP-APN
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:MARIE
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:F01171066
Mailing Address - Street 1:14830 SE 51ST ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5561
Mailing Address - Country:US
Mailing Address - Phone:580-512-9119
Mailing Address - Fax:
Practice Address - Street 1:6744 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2702
Practice Address - Country:US
Practice Address - Phone:580-536-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK90507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily