Provider Demographics
NPI:1205876455
Name:TURNBULL, JACQUELINE (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:TURNBULL
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:TURNBULL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:1 E CLARK BASS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4209
Mailing Address - Country:US
Mailing Address - Phone:918-421-6960
Mailing Address - Fax:918-421-6094
Practice Address - Street 1:3 E CLARK BASS BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4283
Practice Address - Country:US
Practice Address - Phone:918-421-6960
Practice Address - Fax:918-421-6094
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0044148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100013320AMedicaid
OKP00850932OtherRAILROAD MEDICARE
OK100013320AMedicaid
OKM003401029Medicare PIN
OKOK700410Medicare PIN