Organization
FRONTIER REGENERATION GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN TISDALE (PARTNER)
(216) 224-6402
Entity
Organization
Contact information
Practice address
601 NW 198TH ST, EDMOND, OK 73012-1317
(216) 224-6402
Mailing address
601 NW 198TH ST, EDMOND, OK 73012-1317
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/26/2025
Last updated
12/26/2025
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