Healthcare Provider Details

I. General information

NPI: 1609425008
Provider Name (Legal Business Name): JON ANN ESPONGE APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 W WASHINGTON ST
BROKEN ARROW OK
74012-6703
US

IV. Provider business mailing address

911 E JACKSONVILLE ST
BROKEN ARROW OK
74012-1859
US

V. Phone/Fax

Practice location:
  • Phone: 918-280-9679
  • Fax:
Mailing address:
  • Phone: 816-591-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberM0081608
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019034297
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78929-071
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: