Individual provider Active NPI

Jessica D.T. Le

  • Acute Care Clinical Nurse Specialist
  • Tulsa, OK
National Provider Identifier
1811631450
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Clinical Nurse SpecialistTaxonomy code 364SA2100X
License
221149 Issued in OK
Practice address
10505 E 91St St Ste 205
Tulsa, OK 74133-5829
Phone
(918) 307-5490
NPI assigned
Apr 20, 2022
Last updated
Feb 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Clinical Nurse Specialist 364SA2100X 221149 OK Primary

Addresses

Primary practice location

10505 E 91St St Ste 205
Tulsa, OK 74133-5829

Mailing address

10505 E 91St St Ste 205
Tulsa, OK 74133-5829

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250722000038 OK Practitioner - Certified Clinical Nurse Specialist (CNS) 5597271130 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aandr Management Services IncGroup PAC ID 7618248105, 13 clinicians
Prime Medical Group CorpGroup PAC ID 9032597257, 12 clinicians

Practice addresses (Care Compare)

10505 E 91St St
Suite 205
Tulsa, OK 74133-5829
Phone (918) 307-5490

2621 E 38TH St
Tulsa, OK 74105-8206
Phone (708) 724-8599

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
221149OKMDAcute Care Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Medical Group Corp CurrentSince Jul 1, 2025 Accepting new patients
A&R Management Services, Inc. CurrentSince Jul 1, 2025 Accepting new patients

Locations

10505 E 91st St
Ste 205
Tulsa, OK 74133
Phone (708) 724-8599

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1650412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1811631450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 E 91ST ST STE 205",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 E 91ST ST STE 205",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335829",
            "telephone_number": "918-307-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "JESSICA",
        "middle_name": "D.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-20",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SA2100X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Acute Care",
            "state": "OK",
            "license": "221149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.