Provider Demographics
NPI:1275362816
Name:DUNCAN, JESSICA LYNN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W FRESNO AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-2419
Mailing Address - Country:US
Mailing Address - Phone:580-485-9240
Mailing Address - Fax:
Practice Address - Street 1:400 W FRESNO AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-2419
Practice Address - Country:US
Practice Address - Phone:580-485-9240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse