Provider Demographics
NPI:1578778114
Name:FLOKSTRA, JESSICA LYNN
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:FLOKSTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 W 146TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-3554
Mailing Address - Country:US
Mailing Address - Phone:405-547-4066
Mailing Address - Fax:
Practice Address - Street 1:406 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKINS
Practice Address - State:OK
Practice Address - Zip Code:74059-3554
Practice Address - Country:US
Practice Address - Phone:405-547-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant