Provider Demographics
NPI:1538899869
Name:ELDERTON, JODI LYNN (DNP, APRN-CNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:ELDERTON
Suffix:
Gender:F
Credentials:DNP, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-772-4699
Mailing Address - Fax:405-562-4996
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-772-4699
Practice Address - Fax:405-562-4996
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health