Active NPI
Keri Lee Jackson, PT
- Physical Therapist
- Moore, OK
National Provider Identifier
1992004238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT1529
- Practice address
- 2111 Riverwalk Dr
Moore, OK 73160-2700 - Phone
- (405) 636-7174
- NPI assigned
- Mar 25, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT1529 | OK | Primary |
Addresses
Primary practice location
2111 Riverwalk Dr
Moore, OK 73160-2700
Mailing address
2111 Riverwalk Dr
Moore, OK 73160-2700
Phone (405) 636-7174
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 |
|---|---|---|---|
| PT1529 | OK | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1301011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301011200000",
"number": "1992004238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 RIVERWALK DR",
"city": "MOORE",
"state": "OK",
"postal_code": "731602700",
"telephone_number": "405-636-7174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 RIVERWALK DR",
"city": "MOORE",
"state": "OK",
"postal_code": "731602700",
"telephone_number": "405-636-7174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "KERI",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-25",
"last_updated": "2011-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "PT1529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moore, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.