Provider Demographics
NPI:1881662666
Name:GUTHRIE, JENNY LEA (APRN CNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LEA
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 S TOLEDO AVE
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2719
Mailing Address - Country:US
Mailing Address - Phone:918-260-9322
Mailing Address - Fax:
Practice Address - Street 1:9101 S TOLEDO AVE
Practice Address - Street 2:STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2719
Practice Address - Country:US
Practice Address - Phone:918-260-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243712201Medicare PIN
OKP87716Medicare UPIN