Provider Demographics
NPI:1851974653
Name:WILEY, JODI LEE (DO)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:LEE
Last Name:WILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:OSU HEALTH CARE CENTER
Mailing Address - Street 2:2345 SW BLVD
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107
Mailing Address - Country:US
Mailing Address - Phone:918-582-1890
Mailing Address - Fax:918-561-1289
Practice Address - Street 1:6717 S YALE AVE STE 210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3328
Practice Address - Country:US
Practice Address - Phone:918-675-0068
Practice Address - Fax:918-675-5345
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK7654208VP0000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty