Individual provider Active NPI

Jackie Hurst, MSCCC-SLP

  • Speech-Language Pathologist
  • Shawnee, OK
National Provider Identifier
1306936315
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
2892 Issued in OK
Practice address
3903 N Harrison St
Shawnee, OK 74804-1426
Phone
(405) 585-2971
Fax
(405) 585-2983
NPI assigned
Oct 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 2892 OK Primary

Addresses

Primary practice location

3903 N Harrison St
Shawnee, OK 74804-1426

Mailing address

3903 N Harrison St
Shawnee, OK 74804-1426
Phone (405) 585-2971

Other identifiers 1

IdentifierTypeStateIssuer
200088030AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2892OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Foundations Therapy, PLLC Speech-Language Pathologist Past Accepting new patients
Effective Communication LLC Speech-Language Pathologist Past Accepting new patients
Foundations Therapy, PLLC Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1306936315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 N HARRISON ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041426",
            "telephone_number": "405-585-2971",
            "fax_number": "405-585-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 N HARRISON ST",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748041426",
            "telephone_number": "405-585-2971",
            "fax_number": "405-585-2983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HURST",
        "first_name": "JACKIE",
        "credential": "MSCCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "OK",
            "license": "2892",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200088030A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.