Provider Demographics
NPI:1619590502
Name:PATTON, JESSICA COURTNEY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:COURTNEY
Last Name:PATTON
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 1:2737 NW 140TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-6166
Mailing Address - Country:US
Mailing Address - Phone:580-678-8848
Mailing Address - Fax:
Practice Address - Street 1:2737 NW 140TH ST APT 303
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6166
Practice Address - Country:US
Practice Address - Phone:580-678-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program