Jackie Lee McKinnis, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3118 Issued in OK

Practice address

2101 NW Ferris Ave
Lawton, OK 73507

Phone

(580) 357-1581

Fax

(580) 357-4123

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

Yes

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457913600000",
    "number": "1326066291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 NW. FERRIS AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73507",
            "telephone_number": "580-357-1581",
            "fax_number": "580-357-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NW FERRIS AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73507",
            "telephone_number": "580-357-1581",
            "fax_number": "580-357-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNIS",
        "first_name": "JACKIE",
        "middle_name": "LEE",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2016-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "3118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Jean McIntosh, RN
• Briana Theresa McIntyre, OTA/L
• Kaylia McKinney, LMT
• Lilah McKinney
• Tyler Austin McKinney, DO
• Erin E McLemore, MD
• Glenetta Gay McMasters, PTA
• Jesse K McMasters, P.T.A.
• Mimiy McMillian
• Joannita Patricia McMorris

• General Practice Dentistry in Lawton, OK
• Providers in Lawton, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.