Provider Demographics
NPI:1548522998
Name:MEANS, JENNIFER RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENEE
Last Name:MEANS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E 19TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5405
Mailing Address - Country:US
Mailing Address - Phone:918-748-7585
Mailing Address - Fax:918-748-7539
Practice Address - Street 1:1705 E 19TH ST
Practice Address - Street 2:STE 302
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5405
Practice Address - Country:US
Practice Address - Phone:918-748-7585
Practice Address - Fax:918-748-7539
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2084363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200439780 AMedicaid