Individual
JESSICA LEE LUETKEMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 S SAINT LOUIS AVE, TULSA, OK 74120-5440
(918) 619-4400
(918) 619-4696
Mailing address
4502 E 41ST ST, TULSA, OK 74135-2536
(186) 194-4009
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1960
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200318540A
—
OK
Enumeration date
01/24/2011
Last updated
06/08/2022
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