Provider Demographics
NPI:1851974653
Name:WILEY, JODI LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:LEE
Last Name:WILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OSU HEALTH CARE CENTER
Mailing Address - Street 2:2345 SW BLVD
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107
Mailing Address - Country:US
Mailing Address - Phone:918-582-1890
Mailing Address - Fax:918-561-1289
Practice Address - Street 1:2345 SOUTHWEST BLVD OSU HEALTH CARE CENTER
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107
Practice Address - Country:US
Practice Address - Phone:918-582-1980
Practice Address - Fax:918-561-1289
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty