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General NPI Number Information
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NPI Number | 1962293969
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Entity Type | Individual
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Provider Name | LAURA JACKSON DNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 101 W HEFNER RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-6631
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Country | US
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Telephone | 405-896-8058
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Fax | 405-417-4257
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Provider Business Mailing Address
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Address Line | 2 UNIVERSITY PLZ STE 204
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City | HACKENSACK
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State | NJ
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Zip | 07601-6211
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Country | US
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Telephone | 551-295-8223
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 222769
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License Number State | OK
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