Provider Demographics
NPI:1023660578
Name:MCMINN, JAIME L (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:MCMINN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:LIPHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 722791
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-9118
Mailing Address - Country:US
Mailing Address - Phone:405-310-3102
Mailing Address - Fax:405-310-6720
Practice Address - Street 1:1215 CROSSROADS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3359
Practice Address - Country:US
Practice Address - Phone:405-310-2715
Practice Address - Fax:405-310-6720
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily