Provider Demographics
NPI:1740355460
Name:GOEN, JERI CLARK (PA - C)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:CLARK
Last Name:GOEN
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1612 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5233
Mailing Address - Country:US
Mailing Address - Phone:918-902-0434
Mailing Address - Fax:
Practice Address - Street 1:3807 S PEORIA AVE
Practice Address - Street 2:SUITE G AND H
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3145
Practice Address - Country:US
Practice Address - Phone:918-359-7845
Practice Address - Fax:918-359-7849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical