Individual
JODI JENISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
2925 ASTORIA WAY, EDMOND, OK 73034-5997
(405) 254-3000
Mailing address
6 EARLY DAWN DR, EDMOND, OK 73034-7018
(405) 255-9146
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
89504
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
89504
STATE LICENSE
OK
Enumeration date
05/24/2015
Last updated
04/30/2024
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