Healthcare Provider Details

I. General information

NPI: 1619832110
Provider Name (Legal Business Name): JESSICA ANN NICHOLS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA ANN FOSTER LMT

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 E 102ND ST
TULSA OK
74137-7044
US

IV. Provider business mailing address

2401 W OMAHA ST APT 2524
BROKEN ARROW OK
74012-0656
US

V. Phone/Fax

Practice location:
  • Phone: 918-884-7571
  • Fax:
Mailing address:
  • Phone: 918-812-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number195006
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: