Active NPI
Jessica Lynn Wallace
- Community/Behavioral Health Agency
- Muse, OK
National Provider Identifier
1659637478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Practice address
- 26652 Muse Road
Muse, OK 74949 - Phone
- (918) 567-1719
- NPI assigned
- Apr 5, 2012
- Last updated
- Apr 5, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
26652 Muse Road
Muse, OK 74949
Mailing address
Box 26652 St. Hwy. 63
Hodgen, OK 74939
Phone (918) 567-1719
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1659637478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BOX 26652 ST. HWY. 63",
"city": "HODGEN",
"state": "OK",
"postal_code": "74939",
"telephone_number": "918-567-1719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26652 MUSE ROAD",
"city": "MUSE",
"state": "OK",
"postal_code": "74949",
"telephone_number": "918-567-1719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JESSICA",
"middle_name": "LYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-04-05",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muse, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.