Kenneth C Jackson, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

11030 Issued in OK

Practice address

7301 N Comanche Ave
Ou Physicians
Warr Acres, OK 73132-6646

Phone

(405) 721-8090

Fax

(405) 722-8529

NPI assigned

Feb 6, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1801869250
  Medicare reassignment NPD
• Ou Health Partners, Inc

  dba Ou Health Partners

  • Multi-Specialty Clinic/Center
  • Oklahoma City, OK
  • NPI 1528642642
  Medicare reassignment NPD
• Grand Prairie Pediatric and Allergy Clinic

  • Preferred Provider Organization
  • Warr Acres, OK
  • NPI 1588716104
  Authorized official Same address or phone
• Grand Prairie Pediatric and Allergy Clinic Inc

  • Pediatrics Physician
  • Oklahoma City, OK
  • NPI 1952368664
  Authorized official Same address or phone
• Board of Regents of the University of Oklahoma - Ou Physicians

  • Multi-Specialty Clinic/Center
  • Edmond, OK
  • NPI 1124646971
  NPD
• Ou Health Partners, Inc

  dba OUHP Orthotics & Prosthetic

  • Prosthetic/Orthotic Supplier
  • Oklahoma City, OK
  • NPI 1447834460
  NPD

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1457491037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 N COMANCHE AVE",
            "city": "WARR ACRES",
            "state": "OK",
            "postal_code": "731326646",
            "telephone_number": "405-721-8090",
            "fax_number": "405-722-8529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N COMANCHE AVE",
            "address_2": "OU PHYSICIANS",
            "city": "WARR ACRES",
            "state": "OK",
            "postal_code": "731326646",
            "telephone_number": "405-721-8090",
            "fax_number": "405-722-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "KENNETH",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OK",
            "license": "11030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "11030",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard W Howell, D.D.S.
• Abbayael Kani-Ben Israel
• Ashira Israel
• Judaea Israel
• Zakar Israel
• Shelby L Jenkins, MA LPCC
• Jessica Trotter Counseling & Consulting, LLC
• Ricci Jett I
• Gamaliel Jimenez
• Gregory Johnson

• Specialist in Warr Acres, OK
• Providers in Warr Acres, OK by specialty
• Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.