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General NPI Number Information
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NPI Number | 1588328637
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Entity Type | Individual
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Provider Name | EBONY TAMU JACKSON CLTC, CHHA, CCNA
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 5930 E 31ST ST STE 550
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City | TULSA
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State | OK
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Zip | 74135-5121
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Country | US
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Telephone | 918-313-9591
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 E 31ST ST STE 550
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City | TULSA
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State | OK
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Zip | 74135-5121
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Country | US
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Telephone | 918-313-9591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 37V954550119
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 37V954560119
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 37V954550119
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 364SL0600X
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Taxonomy Name | Long-Term Care Clinical Nurse Specialist
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License Number | 37V954550119
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 37V954550119
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License Number State | OK
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