Provider Demographics
NPI:1427525880
Name:HENRY, JESSICA RAE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:HENRY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RAE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN,APRN, FNP-C
Mailing Address - Street 1:114036 N 3690 RD
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-6541
Mailing Address - Country:US
Mailing Address - Phone:918-716-8378
Mailing Address - Fax:
Practice Address - Street 1:114036 N 3690 RD
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-6541
Practice Address - Country:US
Practice Address - Phone:918-716-8378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF09180654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily