Healthcare Provider Details

I. General information

NPI: 1801732870
Provider Name (Legal Business Name): BLOOM PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
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: 918-629-7233
  • Fax:
Mailing address:
  • Phone: 918-629-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER SASSIN
Title or Position: APRN
Credential: APRN
Phone: 918-629-7233