Healthcare Provider Details

I. General information

NPI: 1871132928
Provider Name (Legal Business Name): JESSICA HOPPOCK-SMITH MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 11/27/2023
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 NE 8TH ST
OKLAHOMA CITY OK
73104-5800
US

IV. Provider business mailing address

608 E AMELIA TER
MUSTANG OK
73064-6404
US

V. Phone/Fax

Practice location:
  • Phone: 405-236-3043
  • Fax: 405-239-2390
Mailing address:
  • Phone: 316-393-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1716
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: