Provider Demographics
NPI:1043248701
Name:BARLOW, JEFFERY DAVID (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:BARLOW
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S. SERVICE RD., #6253
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73153-9998
Mailing Address - Country:US
Mailing Address - Phone:888-611-4429
Mailing Address - Fax:888-611-4429
Practice Address - Street 1:601 S SERVICE RD # 6253
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5420
Practice Address - Country:US
Practice Address - Phone:888-611-4429
Practice Address - Fax:888-611-4429
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN0001635CNP363L00000X
OK83548363LC0200X, 363LA2100X
OKR0083548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200523800Medicaid