Provider Demographics
NPI:1437712593
Name:PANNELL, JENNIFER L (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:PANNELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:4631 N. MAY AVE.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-604-0004
Mailing Address - Fax:405-604-0235
Practice Address - Street 1:4631 N. MAY AVE.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6052
Practice Address - Country:US
Practice Address - Phone:405-604-0004
Practice Address - Fax:405-604-0235
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK108578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily