Active NPI
Tracy Lynn Jackson
- Behavior Technician
- Idabel, OK
National Provider Identifier
1639611486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 261QM0801X
- Practice address
- 412 S Central Ave
Idabel, OK 74745-6060 - Phone
- (580) 286-6671
- Fax
- (580) 286-5747
- NPI assigned
- Nov 10, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 261QM0801X | OK | Primary |
Addresses
Primary practice location
412 S Central Ave
Idabel, OK 74745-6060
Mailing address
412 S Central Ave
Idabel, OK 74745-6060
Phone (580) 286-6671
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 261QM0801X | OK | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478736000000",
"number": "1639611486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 S CENTRAL AVE",
"city": "IDABEL",
"state": "OK",
"postal_code": "747456060",
"telephone_number": "580-286-6671",
"fax_number": "580-286-5747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 S CENTRAL AVE",
"city": "IDABEL",
"state": "OK",
"postal_code": "747456060",
"telephone_number": "580-286-6671",
"fax_number": "580-286-5747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TRACY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-10",
"last_updated": "2016-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "OK",
"license": "261QM0801X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idabel, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.