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General NPI Number Information
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NPI Number | 1033968771
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Entity Type | Organization
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Legal Business Name | JESKO WELLNESS
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Dates
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Enumeration Date | 05/15/2024
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 100 S MONROE ST STE 15
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City | ELK CITY
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State | OK
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Zip | 73644-5762
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Country | US
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Telephone | 581-210-9396
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Fax | 580-245-6457
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Provider Business Mailing Address
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Address Line | 2606 E HIGHWAY 66
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City | ELK CITY
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State | OK
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Zip | 73644-9611
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Country | US
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Telephone | 405-345-5366
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Fax | 580-245-6457
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. JOYCY PRANABDEV
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Credential | PMHNP-BC
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Telephone | 580-210-9396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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