Tera Jackson

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Practice address

3109 Stone Hill TRL
Edmond, OK 73034-6180

Phone

(405) 812-4692

NPI assigned

Jan 1, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1325376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1699045104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 PATRICIA DR",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731301637",
            "telephone_number": "405-812-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 STONE HILL TRL",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346180",
            "telephone_number": "405-812-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TERA",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-01",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matt Jackson
• Melissa Kaye Jackson
• Rahjanee Jackson
• Shanda R. Jackson
• Sherena Jackson
• Troy Wayne Jackson, D.C.
• Priscilla Jacky
• Jaclyn I Rowland, PLLC
• Ryan Michael Jacob
• Anne Katherine Jacobs, PH.D.

• Mental Health Clinic/Center (Including Community Mental Health Center) in Edmond, OK
• Providers in Edmond, OK by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.