Provider Demographics
NPI:1750595161
Name:NOBLES-BOTKIN, JILL LYNN (CNM)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:NOBLES-BOTKIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LYNN
Other - Last Name:NOBLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6204 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5629
Mailing Address - Country:US
Mailing Address - Phone:405-470-1562
Mailing Address - Fax:405-947-6432
Practice Address - Street 1:1000 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1207
Practice Address - Country:US
Practice Address - Phone:405-271-4476
Practice Address - Fax:405-271-9202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0047701367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1800477Medicaid