Provider Demographics
NPI:1982329264
Name:PRINCE, JORDYN SYDNEY
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:SYDNEY
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 NW 9TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1012
Mailing Address - Country:US
Mailing Address - Phone:405-231-3913
Mailing Address - Fax:405-772-4484
Practice Address - Street 1:535 NW 9TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1012
Practice Address - Country:US
Practice Address - Phone:405-231-3913
Practice Address - Fax:405-772-4484
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program