Provider Demographics
NPI:1356519060
Name:JENKINS, TERRY J (ARNP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:JENKINS
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 1:1919 S WHEELING AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5638
Mailing Address - Country:US
Mailing Address - Phone:918-403-7200
Mailing Address - Fax:918-293-3110
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-403-7200
Practice Address - Fax:918-293-3110
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0045543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200132330AMedicaid
OKOK400093Medicare PIN