Jessica Lee Luetkemeyer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1960 Issued in OK

Practice address

1111 S Saint Louis Ave
Tulsa, OK 74120-5440

Phone

(918) 619-4400

Fax

(918) 619-4696

NPI assigned

Jan 24, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jessica Lee Heitert Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1003111972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4502 E 41ST ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741352536",
            "telephone_number": "186-194-4009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 S SAINT LOUIS AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741205440",
            "telephone_number": "918-619-4400",
            "fax_number": "918-619-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUETKEMEYER",
        "first_name": "JESSICA",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-24",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200318540A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "HEITERT",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecka Nicole Cupo Lucky
• Stephen Randall Ludiker, ARNP
• Jessalyn Ludley
• Brice Swimmer Luessenhop
• Christian Luessenhop, M.D.
• Amayrani Luevano
• Derrick Lugano
• Thomas C Luiskutty, M.D.
• John Lukeman, DO
• Jason Levi Luker

• Physician Assistant in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.