Healthcare Provider Details

I. General information

NPI: 1033523220
Provider Name (Legal Business Name): JESSICA MARIA YOCUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA MARIA SCOTT

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 N KELLY AVE STE 200
EDMOND OK
73003-3015
US

IV. Provider business mailing address

2820 N KELLY AVE STE 200
EDMOND OK
73003-3015
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-726-8000
  • Fax: 405-726-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number390200000X
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30782
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: