Healthcare Provider Details

I. General information

NPI: 1972956050
Provider Name (Legal Business Name): JESSICA OCKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 NE STALLINGS DR
NACOGDOCHES TX
75965-1608
US

IV. Provider business mailing address

4604 NE STALLINGS DR
NACOGDOCHES TX
75965-1608
US

V. Phone/Fax

Practice location:
  • Phone: 936-559-8770
  • Fax: 936-559-8773
Mailing address:
  • Phone: 936-559-8770
  • Fax: 936-559-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131404
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: