Healthcare Provider Details

I. General information

NPI: 1184397960
Provider Name (Legal Business Name): JESSICA LEE THOMAS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEE VANDERNHEUVEL APRN-CNP

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11495 S STATE HIGHWAY 51
COWETA OK
74429-7138
US

IV. Provider business mailing address

6502 S YALE AVE STE 3410
TULSA OK
74136-8342
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2780
  • Fax: 918-279-7697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204649
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: