Individual
JESSICA DANIELLE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1323 E 71ST ST, TULSA, OK 74136-5045
(918) 935-2551
Mailing address
7224 S ELWOOD AVE APT 24202, TULSA, OK 74132-2453
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
228045
OK
Other
Enumeration date
03/19/2026
Last updated
03/19/2026
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