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General NPI Number Information
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NPI Number | 1366714594
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Entity Type | Individual
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Provider Name | JESSICA LEIGH HAINES PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/03/2012
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 2400 N HIGHWAY 66 STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3073
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Country | US
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Telephone | 918-266-4433
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Fax | 918-266-4244
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Provider Business Mailing Address
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Address Line | 2400 N HIGHWAY 66 STE B
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City | CATOOSA
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State | OK
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Zip | 74015-3073
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Country | US
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Telephone | 918-266-4433
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Fax | 918-266-4244
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2083
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License Number State | OK
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