Active NPI
Jacob Thomas Hiseley, PRSS, LMSW, U/S
- Social Worker
- Tahlequah, OK
National Provider Identifier
1821583402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 20902
- Practice address
- 1640 W Keetoowah St
Tahlequah, OK 74464-3497 - Phone
- (918) 708-9009
- NPI assigned
- Jun 26, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 20902 | OK | Primary |
| Peer Specialist | 175T00000X | 130888 | OK |
Addresses
Primary practice location
1640 W Keetoowah St
Tahlequah, OK 74464-3497
Mailing address
1640 W Keetoowah St
Tahlequah, OK 74464-3497
Phone (918) 708-9009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 130888 | OK | MD | Peer Specialist |
| 20902 | OK | MD | Pain Medicine (Physical Medicine & Rehabilitation) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Country Behavioral Health Services Inc. | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Case Management Agency
- Muskogee, OK
- NPI 1366217697
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766966400000",
"number": "1821583402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1640 W KEETOOWAH ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744643497",
"telephone_number": "918-708-9009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 W KEETOOWAH ST",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744643497",
"telephone_number": "918-708-9009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HISELEY",
"first_name": "JACOB",
"middle_name": "THOMAS",
"credential": "PRSS, LMSW, U/S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-26",
"last_updated": "2025-12-29",
"certification_date": "2025-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OK",
"license": "20902",
"primary": true
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OK",
"license": "130888",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.