Provider Demographics
NPI:1861469363
Name:MCLAIN, JODI D (MSN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:D
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 S YALE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6078
Mailing Address - Country:US
Mailing Address - Phone:918-493-1114
Mailing Address - Fax:918-392-0128
Practice Address - Street 1:10011 S YALE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6078
Practice Address - Country:US
Practice Address - Phone:918-493-1114
Practice Address - Fax:918-392-0128
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO72480363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200026750AMedicaid