Individual provider Active NPI

Jennifer L. Donnelly, DFNP, APRN, NP-BC

  • Family Nurse Practitioner
  • Lawton, OK
National Provider Identifier
1063725547
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
81703 Issued in OK
Practice address
602 SW 38TH St
Lawton, OK 73505-6912
Phone
(580) 248-5780
NPI assigned
Jul 26, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 81703 OK
Family Nurse Practitioner 363LF0000X 81703 OK Primary

Addresses

Primary practice location

602 SW 38TH St
Lawton, OK 73505-6912

Mailing address

1207 Maple Ave
Elgin, OK 73538-9003
Phone (580) 458-2373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200228002190 OK Practitioner - Nurse Practitioner 9931536059 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
81703OKMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Comanche County Hospital Authority CurrentSince May 6, 2025 Accepting new patients
Comanche County Hospital Authority CurrentSince May 6, 2025 Accepting new patients
Comanche County Hospital Authority Past Accepting new patients
Comanche County Healthcare Past Accepting new patients

Locations

7936 US Highway 277
Elgin, OK 73538
Phone (580) 492-6900

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

602 SW 38th St
Lawton, OK 73505

1202 NW Arlington Ave
Lawton, OK 73507
Phone (580) 248-2288

3811 W Gore Blvd
Lawton, OK 73505
Phone (580) 581-1500

5404 SW Lee Blvd
Lawton, OK 73505
Phone (580) 355-5242

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1063725547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 MAPLE AVE",
            "city": "ELGIN",
            "state": "OK",
            "postal_code": "735389003",
            "telephone_number": "580-458-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 SW 38TH ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056912",
            "telephone_number": "580-248-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "DFNP, APRN, NP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-26",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OK",
            "license": "81703",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "81703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.