Individual
JASON R MCHENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
800 N PARK DR, BROKEN BOW, OK 74728-2146
(580) 584-7210
(580) 584-7213
Mailing address
800 N PARK DR, BROKEN BOW, OK 74728-2146
(580) 584-7210
(580) 584-7213
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1255
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015540A
—
OK
Enumeration date
08/10/2005
Last updated
04/14/2022
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