Active NPI
Katie Elizabeth Jackson, MD
- Pediatrics Physician
- Tulsa, OK
National Provider Identifier
1649538414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 30652
- Practice address
- 6161 S Yale Ave
Tulsa, OK 74136-1902 - Phone
- (918) 494-2200
- NPI assigned
- Apr 30, 2012
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 30652 | OK | Primary |
Addresses
Primary practice location
6161 S Yale Ave
Tulsa, OK 74136-1902
Mailing address
6161 S Yale Ave
Tulsa, OK 74136-1902
Other practice location 1
1901 SW H K Dodgen Loop
Temple, TX 76502-1814
Phone (254) 935-4000
Other names 1
- Katie Elizabeth Atnip
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ahs Claremore Regional Hospital LLC | Current | Accepting new patients | |
| Ahs Claremore Regional Hospital, LLC | Current | Accepting new patients | |
| Ahs Oklahoma Physician Group LLC | Pediatrics | Past | Accepting new patients |
Locations
201 W Blue Starr Dr
Claremore, OK 74017
Phone (918) 341-1311
1202 N Muskogee Pl
Claremore, OK 74017
Phone (918) 341-2556
Interoperability endpoints
- https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rural Health Clinic/Center
- Claremore, OK
- NPI 1316579642
-
- Rural Health Clinic/Center
- Claremore, OK
- NPI 1356974687
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1335744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1649538414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6161 S YALE AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741361902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6161 S YALE AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741361902",
"telephone_number": "918-494-2200"
}
],
"practiceLocations": [
{
"address_1": "1901 SW H K Dodgen Loop",
"address_purpose": "LOCATION",
"city": "Temple",
"state": "TX",
"postal_code": "765021814",
"country_code": "US",
"telephone_number": "254-935-4000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACKSON",
"first_name": "KATIE",
"middle_name": "ELIZABETH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-30",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "30652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KATIE",
"last_name": "ATNIP",
"middle_name": "ELIZABETH",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.