Provider Demographics
NPI:1154847127
Name:DUTTON, JESSICA ANNE (MSN, RN, APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:DUTTON
Suffix:
Gender:F
Credentials:MSN, RN, APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 ASHELYNNE CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2618
Mailing Address - Country:US
Mailing Address - Phone:620-617-4640
Mailing Address - Fax:
Practice Address - Street 1:3200 ASHELYNNE CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2618
Practice Address - Country:US
Practice Address - Phone:620-617-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK112051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily