Provider Demographics
NPI:1104344142
Name:PEARCE, JESSICA (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47172 E COUNTY ROAD 1560
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74872-6722
Mailing Address - Country:US
Mailing Address - Phone:405-655-0736
Mailing Address - Fax:
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:580-319-7305
Practice Address - Fax:580-319-7328
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728830Medicaid