Healthcare Provider Details

I. General information

NPI: 1528722923
Provider Name (Legal Business Name): JESSICA ROBISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

1411 E 35TH ST
TULSA OK
74105-2621
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8659
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: