Provider Demographics
NPI:1649639550
Name:JANE M HARMON DNP,RN,PMHNP-BC,PLLC
Entity type:Organization
Organization Name:JANE M HARMON DNP,RN,PMHNP-BC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-236-9886
Mailing Address - Street 1:108 S CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-4848
Mailing Address - Country:US
Mailing Address - Phone:580-236-9886
Mailing Address - Fax:
Practice Address - Street 1:305 DOGWOOD CT
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-6118
Practice Address - Country:US
Practice Address - Phone:580-236-9886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0105058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200434630 AMedicaid