Provider Demographics
NPI:1861816647
Name:LAEGER, JENNIFER DIANE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:LAEGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 S SHERIDAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6776
Mailing Address - Country:US
Mailing Address - Phone:918-619-9400
Mailing Address - Fax:
Practice Address - Street 1:10106 S SHERIDAN RD STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6776
Practice Address - Country:US
Practice Address - Phone:918-619-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2377363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant