Individual provider Active NPI

Kaci Lynn Jackson, ARNP

  • Acute Care Nurse Practitioner
  • Tulsa, OK
National Provider Identifier
1144405937
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R0066985 Issued in OK
Practice address
6151 S Yale Ave Ste 100a
Tulsa, OK 74136-1929
Phone
(918) 494-8500
Fax
(918) 307-5578
NPI assigned
Dec 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R0066985 OK
Acute Care Nurse Practitioner 363LA2100X R0066985 OK Primary

Addresses

Primary practice location

6151 S Yale Ave Ste 100a
Tulsa, OK 74136-1929

Mailing address

6600 S Yale Ave Ste 1400
Tulsa, OK 74136-3331

Other practice location 1

10505 E 91st St
Ste 208
Tulsa, OK 74133
Phone (918) 494-8500

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090729000693 OK Practitioner - Nurse Practitioner 0648323246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Warren Clinic IncGroup PAC ID 8820900293, 787 clinicians

Practice addresses (Care Compare)

6161 S Yale Ave
Tulsa, OK 74136-1902
Phone (918) 502-4720

6600 S Yale Ave
Suite 1400
Tulsa, OK 74136-3331
Phone (918) 488-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R0066985OKMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Warren Clinic Inc CurrentSince Sep 1, 2012 Accepting new patients
Integris Cardiovascular Physicians LLC Past Accepting new patients

Locations

3332 W Okmulgee St
Muskogee, OK 74401
Phone (918) 682-2481

6600 S Yale Ave
Ste 1200
Tulsa, OK 74136
Phone (918) 488-6045

10505 E 91st St
Ste 208
Tulsa, OK 74133
Phone (918) 307-5470

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125

6151 S Yale Ave
Ste 100A
Tulsa, OK 74136
Phone (918) 494-2100

Interoperability endpoints

  • Direct secure messaging: kjackson7802@direct.saintfrancis.com

Organizations & group practices 2

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.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1199059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1144405937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE STE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6151 S YALE AVE STE 100A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361929",
            "telephone_number": "918-494-8500",
            "fax_number": "918-307-5578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10505 E 91st St",
            "address_2": "Ste 208",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "74133",
            "country_code": "US",
            "telephone_number": "918-494-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KACI",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-31",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0066985",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "OK",
            "license": "R0066985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.