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1023648607 NPI number — COURTNEY DYANE JACKSON

NPI Number: 1023648607
Health Care Provider/Practitioner: COURTNEY DYANE JACKSON

Information about “1023648607” NPI (COURTNEY DYANE JACKSON) exists in 1023648607 in HTML format HTML  |  1023648607 in plain Text format TXT  |  1023648607 in PDF (Portable Document Format) PDF  |  1023648607 in an XML format XML  formats.

NPI Number : 1023648607 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023648607",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "COURTNEY",
    "MiddleName": "DYANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TOOMBS",
    "OtherFirstName": "COURTNEY",
    "OtherMiddleName": "DYANE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 189",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARDMORE",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73402-0189",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "580-980-0674",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2425 W UNIVERSITY BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DURANT",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74701-2942",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "580-924-7330",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/22/2020",
    "LastUpdateDate": "08/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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