Provider Demographics
NPI:1952060626
Name:MOYA, JEREMY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MOYA
Suffix:
Gender:M
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 1:1123 S PITTSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-5103
Mailing Address - Country:US
Mailing Address - Phone:918-516-8114
Mailing Address - Fax:
Practice Address - Street 1:1123 S PITTSBURG AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-5103
Practice Address - Country:US
Practice Address - Phone:918-516-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner