Provider Demographics
NPI:1386882009
Name:JUMBO, JOYCE B
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:B
Last Name:JUMBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 E SKELLY DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-6358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3105 E SKELLY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6358
Practice Address - Country:US
Practice Address - Phone:918-949-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0074646163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health