Provider Demographics
NPI:1972683761
Name:BIRKENBUEL, JENNIFER CARLENE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CARLENE
Last Name:BIRKENBUEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CARLENE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PREMISE HEALTH
Mailing Address - Street 2:109 NE 40TH ST
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105
Mailing Address - Country:US
Mailing Address - Phone:405-438-0206
Mailing Address - Fax:405-438-0207
Practice Address - Street 1:5252 N MERIDIAN AVE
Practice Address - Street 2:#105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2178
Practice Address - Country:US
Practice Address - Phone:405-946-3373
Practice Address - Fax:405-949-2387
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200015920AMedicaid
OK243702601Medicare PIN
OK249303601Medicare ID - Type UnspecifiedINDIV. MEDICARE NUMBER
OK200015920AMedicaid