Jimmy A Jackson, TECH

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

221 2ND Ave NW
Ardmore, OK 73401-6202

Phone

(580) 340-9187

Fax

(580) 226-3849

NPI assigned

May 16, 2011

Last updated

May 16, 2011By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Broadway House, Inc.

  • Substance Abuse Rehabilitation Facility
  • Ardmore, OK
  • NPI 1710106778
  NPD (past)

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305504000000",
    "number": "1376836957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 2ND AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734016202",
            "telephone_number": "580-340-9187",
            "fax_number": "580-226-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 2ND AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734016202",
            "telephone_number": "580-340-9187",
            "fax_number": "580-226-3849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JIMMY",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "TECH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-16",
        "last_updated": "2011-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aubrey Isenhower
• IV Health Center
• J & K Inc (All About Backs)
• Jacinto Dialysis LLC (Ardmore Dialysis Ranch)
• Ashley N Jackson
• Raymond Jackson
• Jaclyn S Potts Aprn-Crna PC (South Central Anesthesia)
• Brenda G. Jagger, MS, LPC
• Jahannah H Jamelarin, M.D.
• James Q. McClelland, DPM, PPC

• Mental Health Counselor in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Mental Health Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2011; 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.