Healthcare Provider Details

I. General information

NPI: 1932285285
Provider Name (Legal Business Name): JESSICA OAKS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR STE 180
TROY MI
48098-6366
US

IV. Provider business mailing address

4600 INVESTMENT DR STE 180
TROY MI
48098-6366
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-2210
  • Fax:
Mailing address:
  • Phone: 248-764-4225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number560104875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: