Provider Demographics
NPI:1225588361
Name:STRELLER, JESSICA (DNP, APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STRELLER
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 1:543 E STATE HIGHWAY 152 STE 105
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4502
Mailing Address - Country:US
Mailing Address - Phone:405-645-9106
Mailing Address - Fax:405-577-8404
Practice Address - Street 1:543 E STATE HIGHWAY 152 STE 105
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4502
Practice Address - Country:US
Practice Address - Phone:405-645-9106
Practice Address - Fax:405-577-8404
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily