Provider Demographics
NPI:1124049481
Name:BOTTOMS, JUMOK K (PA)
Entity type:Individual
Prefix:MS
First Name:JUMOK
Middle Name:K
Last Name:BOTTOMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JUMOK
Other - Middle Name:
Other - Last Name:ISENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4303 PITMAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-4473
Mailing Address - Country:US
Mailing Address - Phone:580-483-3643
Mailing Address - Fax:580-483-3643
Practice Address - Street 1:4303 PITMAN & THOMAS RD
Practice Address - Street 2:
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-215-8494
Practice Address - Fax:405-456-7572
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1110207QG0300X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine