Provider Demographics
NPI:1386309169
Name:DICKERSON, JENNIFER HANLEY (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HANLEY
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3650 W ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2202
Mailing Address - Country:US
Mailing Address - Phone:405-364-2666
Mailing Address - Fax:405-364-9627
Practice Address - Street 1:3650 W ROCK CREEK RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-364-2666
Practice Address - Fax:405-364-9627
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215748363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner