MEDICARE: JESSICA LYNN DUNCAN REGISTERED NURSE

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	202668	OK

General Provider Information

NPI Number	:	1275362816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN DUNCAN REGISTERED NURSE

Provider Business Mailing Address
First Line	:	400 W FRESNO AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2419
Country	:	US
Telephone Number	:	580-485-9240
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W FRESNO AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-2419
Country	:	US
Telephone Number	:	580-485-9240
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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