Healthcare Provider Details

I. General information

NPI: 1053247452
Provider Name (Legal Business Name): JP FITNESS HEALTH AND TRAVEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W CHOCTAW AVE
SALLISAW OK
74955-4416
US

IV. Provider business mailing address

103 W CHOCTAW AVE
SALLISAW OK
74955-4416
US

V. Phone/Fax

Practice location:
  • Phone: 918-271-6058
  • Fax:
Mailing address:
  • Phone: 918-271-6058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PETTIT
Title or Position: OWNER
Credential: APRN
Phone: 918-315-1595