Provider Demographics
NPI:1427482801
Name:WASHBOURNE, JAIME (DPH)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:WASHBOURNE
Suffix:
Gender:
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 E FORREST HILLS RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-8880
Mailing Address - Country:US
Mailing Address - Phone:720-552-2111
Mailing Address - Fax:
Practice Address - Street 1:4243 WILL ROGERS PKWY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-2039
Practice Address - Country:US
Practice Address - Phone:405-546-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18053183500000X
OK13790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist