Individual
COURTNEY NICOLE JERSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2301 W I 35 FRONTAGE RD, EDMOND, OK 73013-8515
(405) 757-3365
(405) 757-3499
Mailing address
2301 W I 35 FRONTAGE RD, EDMOND, OK 73013-8515
(405) 757-3365
(405) 757-3499
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4390
OK
363AM0700X
Medical Physician Assistant
PA12364
TX
Other
Enumeration date
11/02/2018
Last updated
06/22/2022
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