Provider Demographics
NPI:1295729788
Name:LOUCKS, JENNIFER JOLEEN (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOLEEN
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-5293
Mailing Address - Country:US
Mailing Address - Phone:580-255-2100
Mailing Address - Fax:
Practice Address - Street 1:1407 N WHISENANT DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1650
Practice Address - Country:US
Practice Address - Phone:580-251-8455
Practice Address - Fax:580-251-8575
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA1015363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical