Provider Demographics
NPI:1871132928
Name:HOPPOCK-SMITH, JESSICA (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:HOPPOCK-SMITH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E AMELIA TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-6404
Mailing Address - Country:US
Mailing Address - Phone:316-393-7807
Mailing Address - Fax:
Practice Address - Street 1:925 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5800
Practice Address - Country:US
Practice Address - Phone:405-236-3043
Practice Address - Fax:405-239-2390
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1716133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1716OtherOKLAHOMA BOARD OF MEDICAL LICENSURE AND SUPERVISION