Healthcare Provider Details

I. General information

NPI: 1114796638
Provider Name (Legal Business Name): JESSICA YOCUM, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
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

5209 YALE BRIDGE CT
EDMOND OK
73034-8742
US

V. Phone/Fax

Practice location:
  • Phone: 405-726-8000
  • Fax: 405-726-8101
Mailing address:
  • Phone: 405-308-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA YOCUM
Title or Position: PHYSICIAN
Credential: MD
Phone: 405-308-8536