Healthcare Provider Details

I. General information

NPI: 1245173558
Provider Name (Legal Business Name): LINDSEY JACKSON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2026
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 BROADWAY EXT
OKLAHOMA CITY OK
73114-6303
US

IV. Provider business mailing address

2501 N BLACKWELDER AVE
OKLAHOMA CITY OK
73106-1402
US

V. Phone/Fax

Practice location:
  • Phone: 405-419-2980
  • Fax:
Mailing address:
  • Phone: 405-208-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0103425
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: