Dezjuan Vonte Jackson

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

314007 Issued in OK

Practice address

10461 N May Ave
Oklahoma City, OK 73120-2610

Phone

(405) 543-6314

NPI assigned

Feb 20, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1519084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519084800000",
    "number": "1679073183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 N MAY AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731202610",
            "telephone_number": "405-543-6314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10461 N MAY AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731202610",
            "telephone_number": "405-543-6314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEZJUAN",
        "middle_name": "VONTE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-20",
        "last_updated": "2018-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OK",
            "license": "314007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Jackson
• Claire Zimmerman Jackson, MA, CCC-SLP
• David Duane Jackson
• David W. Jackson, M.D.
• Demetra Shan Jackson, B.S.
• Dwight L Jackson
• Elizabeth Ann Jackson, APRN-CNS
• Erin Elizabeth Jackson, MSW
• Ernest Jackson Jr., B.S. M.DIV
• Geena Jackson

• Prosthetic/Orthotic Supplier in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Prosthetic/Orthotic Supplier in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2018; 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.