Basic Information
| Provider Information | |||||||||
| NPI: | 1376825596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAVER | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N.E. 10TH STREET | ||||||||
| Address2: | SUITE 5050 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052717770 | ||||||||
| FaxNumber: | 4052712766 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N.E. 10TH STREET | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052718707 | ||||||||
| FaxNumber: | 4052712976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2011 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 79370 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.