Healthcare Provider Details

I. General information

NPI: 1770373466
Provider Name (Legal Business Name): JESSICA JEANNINE PERKINS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 HOSPITAL RD
HEALDTON OK
73438-6124
US

IV. Provider business mailing address

662 MARSDEN RD
OVERBROOK OK
73453-5516
US

V. Phone/Fax

Practice location:
  • Phone: 580-229-0079
  • Fax:
Mailing address:
  • Phone: 580-504-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR0102436
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223328
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: