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General NPI Number Information
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NPI Number | 1497561237
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Entity Type | Individual
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Provider Name | JESSICA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 904 DALLAS ST
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City | TALIHINA
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State | OK
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Zip | 74571
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Country | US
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Telephone | 918-942-1033
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Fax | 918-574-6150
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Provider Business Mailing Address
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Address Line | 162948 N 4346 LN
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City | TUSKAHOMA
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State | OK
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Zip | 74574-5917
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Country | US
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Telephone | 918-415-4596
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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