| Doctor Name: | JODI JENISTA |
| NPI Number: | 1104205186 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-CNP |
| License Number: | 89504 |
| Business Practice Address: | 6820 Nw 23rd St Bethany, OK - 730085217 |
| Business Phone Number: | 4054955154 |
| Business Fax Number: | 4056014888 |
| Mailing Address: | 6820 Nw 23rd St, BETHANY |
| State: | OK |
| Postal Code: | 730085217 |
| Phone Number: | 4054955154 |
| Fax Number: | 4056014888 |
| NPI Enumeration Date: | 05/24/2015 |
| NPI Last Update Date: | 05/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 89504 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |