Provider Demographics
NPI:1851869036
Name:HARDCASTLE, JESSICA LOUISE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LOUISE
Last Name:HARDCASTLE
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 1:507 NE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-1906
Mailing Address - Country:US
Mailing Address - Phone:918-430-6682
Mailing Address - Fax:
Practice Address - Street 1:26243 STATE HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-8740
Practice Address - Country:US
Practice Address - Phone:918-825-1405
Practice Address - Fax:918-999-0109
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator