Provider Demographics
NPI:1649842303
Name:MARTIN, JESSICA E (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:800 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5418
Mailing Address - Country:US
Mailing Address - Phone:405-271-1112
Mailing Address - Fax:
Practice Address - Street 1:4401 MCAULEY BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8561
Practice Address - Country:US
Practice Address - Phone:405-751-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily