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NPI Code Detail

MEDICARE: RANDI JACKSON

MEDICARE: RANDI JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1265158497
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDI JACKSON
Provider Business Mailing Address
First Line : 1006 NE 17TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73111-1002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1006 NE 17TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73111-1002
Country : US
Telephone Number : 405-427-3200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2022
Last Update Date : 10/19/2022

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Directions to “ RANDI JACKSON ” Practice Location

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