Jacklyn Dawn Rose, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

92995 Issued in OK

Practice address

303 E Taft Ave Ste 3
Sapulpa, OK 74066-5651

Phone

(918) 224-2222

NPI assigned

Aug 5, 2018

Sex

Female

Sole proprietor

No

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

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Prophylaxis Healthcare LLCGroup PAC ID 3072784289, 26 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St John Medical Center Hospital, Tulsa, OK, CCN 370114
• Ascension St John Sapulpa Hospital, Sapulpa, OK, CCN 371312

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Prophylaxis Healthcare LLC

  • Multi-Specialty Clinic/Center
  • Bixby, OK
  • NPI 1538453923
  Medicare reassignment Care Compare group NPD
• Prophylaxis Healthcare LLC

  • Community/Behavioral Health Agency
  • Bixby, OK
  • NPI 1285438317
  NPD
• St John Sapulpa, Inc.

  • Critical Access Hospital
  • Sapulpa, OK
  • NPI 1922076603
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St John Medical Center Inc

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1154417368
  Care Compare affiliation
• St John Medical Center Inc

  • Rehabilitation Hospital Unit
  • Tulsa, OK
  • NPI 1578656161
  Care Compare affiliation
• St John Sapulpa, Inc.

  • Critical Access Hospital
  • Sapulpa, OK
  • NPI 1922076603
  Care Compare affiliation

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

{
    "created_epoch": "1533427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533427200000",
    "number": "1700364387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E TAFT AVE STE 3",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740665651",
            "telephone_number": "918-224-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E TAFT AVE STE 3",
            "city": "SAPULPA",
            "state": "OK",
            "postal_code": "740665651",
            "telephone_number": "918-224-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "JACKLYN",
        "middle_name": "DAWN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-05",
        "last_updated": "2018-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "92995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger L Kinney MD PC
• Rachael Lynette Rogers, LPN
• Todd Rokisky, PHARMD
• April Ronquillo, RN
• Roper Medical Corporation
• Dana Michelle Ross, D.D.S
• Dawn Ross
• Jack Rothstein
• Victoria N Rush- Wilson, LPN
• Britnei Alys Russell-Tyler

• Family Nurse Practitioner in Sapulpa, OK
• Providers in Sapulpa, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.