Healthcare Provider Details

I. General information

NPI: 1811856891
Provider Name (Legal Business Name): JESSICA NELL HOWARD MACK DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 SE 29TH ST STE 3018
DEL CITY OK
73115-3335
US

IV. Provider business mailing address

4330 SE 29TH ST STE 3018
DEL CITY OK
73115-3335
US

V. Phone/Fax

Practice location:
  • Phone: 405-670-8100
  • Fax: 405-670-8558
Mailing address:
  • Phone: 405-670-8100
  • Fax: 405-670-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number229953
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: