Provider Demographics
NPI:1124469028
Name:JAYNE ROZELL APRN-CNP PLLC
Entity type:Organization
Organization Name:JAYNE ROZELL APRN-CNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-CNP,OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-821-4071
Mailing Address - Street 1:20272 E 1280 RD
Mailing Address - Street 2:
Mailing Address - City:CARTER
Mailing Address - State:OK
Mailing Address - Zip Code:73627-2725
Mailing Address - Country:US
Mailing Address - Phone:580-393-2386
Mailing Address - Fax:
Practice Address - Street 1:1710 W 3RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5159
Practice Address - Country:US
Practice Address - Phone:580-225-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88982363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200501190AMedicaid
OK200501190AMedicaid