Basic Information
| Provider Information | |||||||||
| NPI: | 1013422310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HYMAN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | RAYLEEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 TERRA DR | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738019596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802901810 | ||||||||
| FaxNumber: | 8333071865 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 TERRA DR | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738019596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802901810 | ||||||||
| FaxNumber: | 8333071865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2017 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN.0993598-NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 203872 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.