Healthcare Provider Details

I. General information

NPI: 1528736097
Provider Name (Legal Business Name): JENNIFER SUE SASSIN APRN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 S SHERIDAN RD STE A
TULSA OK
74133-6742
US

IV. Provider business mailing address

735 E 129TH PL S
JENKS OK
74037-3722
US

V. Phone/Fax

Practice location:
  • Phone: 918-395-5707
  • Fax: 918-921-8136
Mailing address:
  • Phone: 918-629-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201598
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: