Provider Demographics
NPI:1588108187
Name:KING, JENNA N (ARNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:N
Last Name:KING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4441
Mailing Address - Country:US
Mailing Address - Phone:189-537-1973
Mailing Address - Fax:918-537-1027
Practice Address - Street 1:1143B N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4441
Practice Address - Country:US
Practice Address - Phone:189-537-1973
Practice Address - Fax:918-537-1027
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77499-052363LF0000X
OK210367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily