Healthcare Provider Details

I. General information

NPI: 1033766167
Provider Name (Legal Business Name): JESSICA SUSAN CULPEPPER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 OK-66
STROUD OK
74079
US

IV. Provider business mailing address

3101 BEACON HILL ST
EDMOND OK
73034-8339
US

V. Phone/Fax

Practice location:
  • Phone: 918-968-3571
  • Fax:
Mailing address:
  • Phone: 918-968-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number69743
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69743
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number69743
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: