Provider Demographics
NPI:1356799142
Name:VANDERFORD, JENNIFER JANETTE (APRN NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANETTE
Last Name:VANDERFORD
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W BOISE CIR STE 160
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4932
Mailing Address - Country:US
Mailing Address - Phone:918-994-9160
Mailing Address - Fax:
Practice Address - Street 1:800 W BOISE CIR STE 160
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4932
Practice Address - Country:US
Practice Address - Phone:918-994-9160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily