Provider Demographics
NPI:1033968771
Name:JESKO WELLNESS
Entity type:Organization
Organization Name:JESKO WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRANABDEV
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:580-210-9396
Mailing Address - Street 1:2606 E HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-9611
Mailing Address - Country:US
Mailing Address - Phone:405-345-5366
Mailing Address - Fax:580-245-6457
Practice Address - Street 1:100 S MONROE ST STE 15
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5762
Practice Address - Country:US
Practice Address - Phone:581-210-9396
Practice Address - Fax:580-245-6457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1033968771Medicaid
OK1194429829OtherPSYCHIATRRY
OK201264530Medicaid