Healthcare Provider Details

I. General information

NPI: 1144184243
Provider Name (Legal Business Name): JESSICA LYNN BEAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

701 W BLAIR AVE
WILBURTON OK
74578-3427
US

IV. Provider business mailing address

701 W BLAIR AVE
WILBURTON OK
74578-3427
US

V. Phone/Fax

Practice location:
  • Phone: 501-733-3039
  • Fax:
Mailing address:
  • Phone: 501-733-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number220244
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: