Healthcare Provider Details

I. General information

NPI: 1346759172
Provider Name (Legal Business Name): MS. JESSICA ANN STOOPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3037 NW 63RD ST STE 201W
OKLAHOMA CITY OK
73116
US

IV. Provider business mailing address

1605 NW 126TH ST
OKLAHOMA CITY OK
73120-5064
US

V. Phone/Fax

Practice location:
  • Phone: 918-533-6916
  • Fax:
Mailing address:
  • Phone: 918-533-6916
  • 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 Code101YM0800X
TaxonomyMental Health Counselor
License Number7073
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: