Individual
JODIE JANE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1501A E WADE WATTS AVE, MCALESTER, OK 74501-5651
(918) 302-0900
(918) 302-0929
Mailing address
1501A E WADE WATTS AVE, MCALESTER, OK 74501-5651
(918) 302-0900
(918) 302-0929
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0073757
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200219910A
—
OK
Enumeration date
09/23/2008
Last updated
02/17/2011
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