Provider Demographics
NPI:1164787370
Name:MOCK, JENNA CHRISTINE (PA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:CHRISTINE
Last Name:MOCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:CHRISTINE
Other - Last Name:NEGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3433 NW 56TH ST STE 660
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4449
Mailing Address - Country:US
Mailing Address - Phone:405-947-3341
Mailing Address - Fax:405-951-4356
Practice Address - Street 1:3433 NW 56TH ST STE 660
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4449
Practice Address - Country:US
Practice Address - Phone:059-473-3414
Practice Address - Fax:405-951-4356
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant