NPIMap

Organization Active NPI

North Okaloosa Clinic Corp

  • General Practice Physician
  • Crestview, FL
National Provider Identifier
1154994697
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
NORTH OKALOOSA CLINIC CORP
Practice address
1332 N Ferdon Blvd
Crestview, FL 32536-1749
Phone
(850) 398-8725
Fax
(850) 398-8727
NPI assigned
Jul 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

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

Authorized official

Name
Jennifer L Jackson
Title
Sr Dir Prov Enrollment & Onboarding
Phone
(615) 465-3334

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1332 N Ferdon Blvd
Crestview, FL 32536-1749

Mailing address

PO Box 689022
Franklin, TN 37068-9022
Phone (615) 465-7211

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidFL

Other names 2

  • NOPG Walk- In Clinic Doing business as
  • North Okaloosa Clinic Corp Doing business as

National Provider Directory

National Provider Directory
Tax ID family
North Okaloosa Clinic Corp12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1154994697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022",
            "telephone_number": "615-465-7211",
            "fax_number": "615-628-6877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1332 N FERDON BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325361749",
            "telephone_number": "850-398-8725",
            "fax_number": "850-398-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH OKALOOSA CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-22",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR DIR PROV ENROLLMENT & ONBOARDING",
        "authorized_official_telephone_number": "615-465-3334"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NOPG Walk- In Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Okaloosa Clinic Corp",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Okaloosa Clinic Corp",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.