Jumok K Bottoms, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1110 Issued in OK

Practice address

4303 Pitman & Thomas Rd
Ft Sill, OK 73503

Phone

(580) 215-8494

Fax

(405) 456-7572

NPI assigned

Jul 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jumok Isenberg Former name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1124049481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4303 PITMAN ST",
            "city": "FORT SILL",
            "state": "OK",
            "postal_code": "735034473",
            "telephone_number": "580-483-3643",
            "fax_number": "580-483-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 PITMAN & THOMAS RD",
            "city": "FT SILL",
            "state": "OK",
            "postal_code": "73503",
            "telephone_number": "580-215-8494",
            "fax_number": "405-456-7572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTOMS",
        "first_name": "JUMOK",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-22",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OK",
            "license": "1110",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JUMOK",
            "last_name": "ISENBERG",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ahren Scott Blake, DDS
• Lexy Lynn Blake, DMD
• Phillip Blake, PHARMD
• Margaret Theresa Bleckler, OTR
• Jared T Bosh, DMD
• Jeremy Bouwhuis, D.O.
• Lori Bridges, PHARM.D
• Brian Bromley, D.O.
• Angelyn Marie Brown, DNP
• Austin Carroll Brown, PA

• All providers in Ft Sill, OK
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.