MEDICARE: JESSICA RENEE THURSTON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R0102435	OK
2	363L00000X	Nurse Practitioner	227227	OK

General Provider Information

NPI Number	:	1184580524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RENEE THURSTON RN

Provider Business Mailing Address
First Line	:	4300 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8362
Country	:	US
Telephone Number	:	405-755-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 14TH AVE NW
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1828
Country	:	US
Telephone Number	:	580-223-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	01/27/2026

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