Scotty Jackson, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

211329 Issued in OK

Practice address

34550 Airline Rd
Pauls Valley, OK 73075-9337

Phone

(405) 207-9238

Fax

(405) 207-9240

NPI assigned

Jan 11, 2023

Last updated

Jul 11, 2023By the provider in NPPES

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

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Purcell Municipal Hospital Hospital, Purcell, OK, CCN 370158
• Norman Regional Hospital, Norman, OK, CCN 370008

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pauls Valley Family Healthcare Aprn FNP-BC LLC

  • Primary Care Clinic/Center
  • Pauls Valley, OK
  • NPI 1407553597
  Medicare reassignment NPD Authorized official

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

• Norman Regional Hospital Authority

  dba Norman Regional

  • General Acute Care Hospital
  • Norman, OK
  • NPI 1700882578
  Care Compare affiliation
• Purcell Municipal Hospital

  • General Acute Care Hospital
  • Purcell, OK
  • NPI 1467476911
  Care Compare affiliation
• Purcell Municipal Hospital

  • General Acute Care Hospital
  • Purcell, OK
  • NPI 1851669865
  Care Compare affiliation

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

{
    "created_epoch": "1673395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1750095980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34550 AIRLINE RD",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730759337",
            "telephone_number": "405-207-9238",
            "fax_number": "405-207-9240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34550 AIRLINE RD",
            "city": "PAULS VALLEY",
            "state": "OK",
            "postal_code": "730759337",
            "telephone_number": "405-207-9238",
            "fax_number": "405-207-9240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "SCOTTY",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0078720",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "211329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann Hull, DPH
• Hali Humphrey
• Jack Justice (Reavis Rexall Drug)
• Jack Justice (Reavis Super Drug)
• Letitia Lynn Jackson, APRN-CNP
• Cynthia A. Jacobson, DPH.
• James R Ward, Family Dentistry, PC
• Linda Liffy James, MD
• Jamie L. Means, DDS, PLLC
• Jee Hun Jang, DO

• Family Nurse Practitioner in Pauls Valley, OK
• Providers in Pauls Valley, 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 Jul 11, 2023; 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.