Basic Information
| Provider Information | |||||||||
| NPI: | 1801816160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YELVERTON | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26706 | ||||||||
| Address2: | SECTION NUMBER 4148 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731260706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172849859 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 W ALBANY ST | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740128146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172849850 | ||||||||
| FaxNumber: | 8172849859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 01/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 19953 | OK | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 100084120A | 05 | OK | MEDICAID |