1154847127 NPI number — MRS. JESSICA ANNE DUTTON MSN, RN, APRN-CNP

Table of content: MRS. JESSICA ANNE DUTTON MSN, RN, APRN-CNP (NPI 1154847127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154847127 NPI number — MRS. JESSICA ANNE DUTTON MSN, RN, APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUTTON
Provider First Name:
JESSICA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, APRN-CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154847127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 ASHELYNNE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMOND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73034-2618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-617-4640
Provider Business Mailing Address Fax Number:
405-938-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3431 S BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73013-5475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-673-3773
Provider Business Practice Location Address Fax Number:
405-938-1445
Provider Enumeration Date:
08/21/2017

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: 363LF0000X , with the licence number:  112051 , 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)





Copyright © 2007-2025 www.npivalidator.com