Jeri L Ellis MD, MPH, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

JERI L ELLIS MD, MPH, PC

Practice address

420 N Kickapoo Ave
Shawnee, OK 74801-6643

Phone

(400) 581-6331

NPI assigned

Nov 7, 2017

Organization subpart

No

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

Authorized official

Name

Denise Cato

Title

Contracting Manager

Phone

(405) 470-1884

Specialties & licenses 2

Addresses

Other names 1

• Ellis Family Practice Doing business as

Locations

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

{
    "created_epoch": "1510012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510012800000",
    "number": "1538672001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 NW EXPRESSWAY STE 360",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731325149",
            "telephone_number": "405-470-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N KICKAPOO AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748016643",
            "telephone_number": "400-581-6331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERI L ELLIS MD, MPH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-07",
        "last_updated": "2017-11-07",
        "status": "A",
        "authorized_official_last_name": "CATO",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CONTRACTING MANAGER",
        "authorized_official_telephone_number": "405-470-1884"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellis Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kim Jenkins
• Amy Adelle Jennings, M.S., LPC-C
• Mary Melissa Jennings
• Paul Douglas Jennings, MD
• Stephanie A. Jennings, LPC
• Kevin Jett, LMFT, LADC
• Valari Jett, MS
• Monica Jinkins
• Daniel Jo, PHARMD
• Maria Elaine Joelson, NP-C

• Primary Care Clinic/Center in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.