Elizabeth Renee Jackson

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1301 W 6TH Ave
Stillwater, OK 74074-4375

Phone

(405) 533-1074

NPI assigned

Nov 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stillwater Medical Center AuthorityGroup PAC ID 2365353794, 155 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elizabeth.jackson.p1@direct.smc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stillwater Medical Center Authority

  • Family Medicine Physician
  • Stillwater, OK
  • NPI 1558377135
  Medicare reassignment Care Compare group NPD
• Stillwater Medical Center Authority

  • Family Medicine Physician
  • Perry, OK
  • NPI 1407729361
  NPD
• Stillwater Medical Center Physicians

  • Anesthesiology Physician
  • Stillwater, OK
  • NPI 1295859387
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Stillwater Medical Center Authority

  • General Acute Care Hospital
  • Stillwater, OK
  • NPI 1164494027
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1043033129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4622 N ROGERS DR",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740751654",
            "telephone_number": "580-716-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W 6TH AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744375",
            "telephone_number": "405-533-1074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ELIZABETH",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-06",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Val Gene Iven, M.D.
• Kristin Elizabeth Iwata, RBT
• Kristyna Lenee Iyer, MD
• Nina Jabrzemski, PT, DPT
• Cortney Jackson
• Michael Paul Jackson
• Myriah Jackson
• Staci Jacques, M.ED.
• Bretton H. Jameson, M.D.
• John Thomas Jardot

• Medical Physician Assistant in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Medical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.