Provider Demographics
NPI:1336766112
Name:MEYERS, JORDAN LYNEL
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNEL
Last Name:MEYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 NORTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-2343
Mailing Address - Country:US
Mailing Address - Phone:918-345-0285
Mailing Address - Fax:
Practice Address - Street 1:3420 NORTHVIEW DR
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421-2343
Practice Address - Country:US
Practice Address - Phone:918-345-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK110965163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice