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General NPI Number Information
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NPI Number | 1194098681
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Entity Type | Individual
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Provider Name | JESSICA MARIE WELLS-BURRIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 701 NE 10TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5403
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Country | US
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Telephone | 405-232-8003
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Fax | 405-232-8008
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Provider Business Mailing Address
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Address Line | 1226 N SHARTEL AVENUE SUITE 300
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-5403
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Country | US
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Telephone | 405-605-8280
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Fax | 405-232-8008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2102
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License Number State | OK
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