Individual
JESSICA LANAE POE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(803) 795-8605
(580) 379-5859
Mailing address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5000
(580) 379-5509
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
89966
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200131810A
—
OK
Enumeration date
01/15/2008
Last updated
08/29/2022
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