Jerdan Dermatology Laser and Aesthetic Institute PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

JERDAN DERMATOLOGY LASER AND AESTHETIC INSTITUTE PLLC

Practice address

1211 N Shartel Ave Ste 802
Oklahoma City, OK 73103-2425

Phone

(405) 212-2280

Fax

(405) 493-9200

NPI assigned

Dec 31, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kimberly Jerdan, MDNPI 1821431891

Title

MD/Owner

Phone

(405) 212-2280

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00172

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Rachel Jerdan, M.D.

  • Dermatology Physician
  • Oklahoma City, OK
  • NPI 1821431891
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1033706445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 N SHARTEL AVE STE 802",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731032425",
            "telephone_number": "405-212-2280",
            "fax_number": "405-493-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 N SHARTEL AVE STE 802",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731032425",
            "telephone_number": "405-212-2280",
            "fax_number": "405-493-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERDAN DERMATOLOGY LASER AND AESTHETIC INSTITUTE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-31",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "JERDAN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "405-212-2280",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lea Jensen, BS IN LEADERSHIP
• Margaret Elizabeth Jensen, PA-C
• Nathan Jensen
• Shelby Lynn Jensen, IBCLC
• Zoe Jeon
• Kimberly Rachel Jerdan, M.D.
• Christopher Jerden
• Jeremy M Boucher, MD; PLLC
• Jeri Ellis MD MPH PC
• Lauren Jerichow, APRN-CNP

• Dermatology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.