Provider Demographics
NPI:1003781808
Name:FARMER, JESSE MICHAEL SR (RN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:MICHAEL
Last Name:FARMER
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 N 4080 RD
Mailing Address - Street 2:
Mailing Address - City:BOSWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74727-9265
Mailing Address - Country:US
Mailing Address - Phone:660-654-4009
Mailing Address - Fax:
Practice Address - Street 1:1252 N 4080 RD
Practice Address - Street 2:
Practice Address - City:BOSWELL
Practice Address - State:OK
Practice Address - Zip Code:74727-9265
Practice Address - Country:US
Practice Address - Phone:660-654-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014022224163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice