1356983324 NPI number — MS. JESSICA ANN JARVIS PARAPROFESSIONAL

Table of content: MS. JESSICA ANN JARVIS PARAPROFESSIONAL (NPI 1356983324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356983324 NPI number — MS. JESSICA ANN JARVIS PARAPROFESSIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARVIS
Provider First Name:
JESSICA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PARAPROFESSIONAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODSIDE
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356983324
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STILWELL PUBLIC SCHOOL
Provider Second Line Business Mailing Address:
520 W. DIVISION ST.
Provider Business Mailing Address City Name:
STILWELL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-696-7001
Provider Business Mailing Address Fax Number:
918-696-6824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STILWELL PUBLIC SCHOOL
Provider Second Line Business Practice Location Address:
520 W. DIVISION ST.
Provider Business Practice Location Address City Name:
STILWELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-696-7001
Provider Business Practice Location Address Fax Number:
918-696-6824
Provider Enumeration Date:
10/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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