1659526739 NPI number — MRS. JONATHAN R TRIPLETT

Table of content: MRS. JONATHAN R TRIPLETT (NPI 1659526739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659526739 NPI number — MRS. JONATHAN R TRIPLETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIPLETT
Provider First Name:
JONATHAN
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659526739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 N CLASSEN BLVD
Provider Second Line Business Mailing Address:
STE 128
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118-4627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-879-0482
Provider Business Mailing Address Fax Number:
405-879-0484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 N CLASSEN BLVD
Provider Second Line Business Practice Location Address:
STE 128
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73118-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-879-0482
Provider Business Practice Location Address Fax Number:
405-879-0484
Provider Enumeration Date:
11/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200079250A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com