Provider Demographics
NPI:1003986563
Name:DODSON, JODI M (ARNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:M
Last Name:DODSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 PROVIDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4142
Mailing Address - Country:US
Mailing Address - Phone:405-340-3971
Mailing Address - Fax:
Practice Address - Street 1:1139 36TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4103
Practice Address - Country:US
Practice Address - Phone:405-217-9997
Practice Address - Fax:405-307-8520
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0053999363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100030AMedicaid
OK249704702Medicare PIN
OKOK700555Medicare PIN