Individual
JESTON WAYNE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
48407 SANDY ROCK RD, EARLSBORO, OK 74840-8665
(405) 214-8863
Mailing address
48407 SANDY ROCK RD, EARLSBORO, OK 74840-8665
(405) 214-8863
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
133212
OK
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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