Provider Demographics
NPI:1760879076
Name:GEOHAGAN, JENNA (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GEOHAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 W WRANGLER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-1900
Mailing Address - Country:US
Mailing Address - Phone:405-716-3070
Mailing Address - Fax:405-716-3069
Practice Address - Street 1:2403 W WRANGLER BLVD STE C
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-1900
Practice Address - Country:US
Practice Address - Phone:405-716-3070
Practice Address - Fax:405-716-3069
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine