Provider Demographics
NPI:1174911580
Name:BRYCE, JESSIE HALL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:HALL
Last Name:BRYCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:LYNN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3123 E. 37TH STREET
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-232-8779
Mailing Address - Fax:918-592-1021
Practice Address - Street 1:1265 S UTICA AVE STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-592-1021
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant