Ebony Tamu Jackson, CLTC, CHHA, CCNA

Primary specialty

SpecialistTaxonomy code 174400000X

License

37V954550119 Issued in OK

Practice address

5930 E 31St St Ste 550
Tulsa, OK 74135-5121

Phone

(918) 313-9591

NPI assigned

Oct 25, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1588328637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5930 E 31ST ST STE 550",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355121",
            "telephone_number": "918-313-9591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5930 E 31ST ST STE 550",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741355121",
            "telephone_number": "918-313-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "EBONY",
        "middle_name": "TAMU",
        "name_prefix": "Mrs.",
        "credential": "CLTC, CHHA, CCNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": "OK",
            "license": "37V954550119",
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "OK",
            "license": "37V954560119",
            "primary": false
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "OK",
            "license": "37V954550119",
            "primary": false
        },
        {
            "code": "364SL0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Long-Term Care",
            "state": "OK",
            "license": "37V954550119",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "OK",
            "license": "37V954550119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Damien Jackson
• Dana Lynn Jackson, LADC UNDER SUPER
• Darian J Jackson
• Donnelle Keelyn Jackson
• Douglas Wayne Jackson, DDS
• Elissa Nacole Jackson, RESIDENT ASSISTANT
• Erica Jackson
• Erin L Jackson
• Glenn Allen Jackson II
• Hannah Joy Jackson

• Specialist in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Specialist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.