Healthcare Provider Details

I. General information

NPI: 1902078728
Provider Name (Legal Business Name): CHOCTAW NATION OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 W LIBERTY RD
ATOKA OK
74525-1702
US

IV. Provider business mailing address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-1981
  • Fax:
Mailing address:
  • Phone: 918-567-7000
  • Fax: 918-567-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA KAY JACKSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-567-7000