Pauls Valley Family Healthcare Aprn FNP-BC LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PAULS VALLEY FAMILY HEALTHCARE APRN FNP-BC LLC

Practice address

34550 Airline Rd
Pauls Valley, OK 73075-9337

Phone

(405) 207-9238

Fax

(405) 207-9240

NPI assigned

Feb 9, 2023

Organization subpart

No

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

Authorized official

Name

Scotty Eugene Jackson, APRN-FNP-BCNPI 1750095980

Title

Nurse Practitioner / Owner

Phone

(405) 207-9238

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scotty Jackson, FNP-BC

  • Family Nurse Practitioner
  • Pauls Valley, OK
  • NPI 1750095980
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1675900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1407553597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34550 AIRLINE RD",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730759337",
            "telephone_number": "405-207-9238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34550 AIRLINE RD",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730759337",
            "telephone_number": "405-207-9238",
            "fax_number": "405-207-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULS VALLEY FAMILY HEALTHCARE APRN FNP-BC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-09",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SCOTTY",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER / OWNER",
        "authorized_official_telephone_number": "405-207-9238",
        "authorized_official_credential": "APRN-FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA STATE  BOARD OF NURSING",
            "identifier": "211329",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karri Odell
• Nikki Michelle Patton
• Pauls Valley Care Center LLC (Pauls Valley Care Center)
• Pauls Valley Chiropractic
• Pauls Valley Eye Clinic PLLC
• Pauls Valley General Hospital
• Pauls Valley General Hospital (Pauls Valley General Hospital Home Services)
• Pauls Valley General Hospital (Valley Hospice)
• Pauls Valley General Hospital
• Pauls Valley General Hospital (Pauls Valley Physicians Clinic)

• Primary Care Clinic/Center in Pauls Valley, OK
• Providers in Pauls Valley, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.