Krishaun Jackson
Individual provider Active NPI Counselor · Spencer, OK
NPI 1144580341 · NPPES record last updated May 22, 2012
Key facts
- NPI
- 1144580341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 10901 N.E 59TH St.
Spencer, OK 73084 - Phone
- (405) 881-7080
- NPI assigned
- May 22, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
10901 N.E 59TH St.
Spencer, OK 73084
Mailing address
10901 NE 59TH St
Spencer, OK 73084-5019
Other providers in Spencer, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.