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NPI Code Detail

MEDICARE: AMBER JACK BSN, RN

MEDICARE: AMBER JACK BSN, RN
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
1390200000XStudent in an Organized Health Care Education/Training Program24517356OK

General Provider Information

NPI Number : 1619801081
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER JACK BSN, RN
Provider Business Mailing Address
First Line : 1100 N LINDSAY AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5410
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N LINDSAY AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5410
Country : US
Telephone Number : 405-271-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2026
Last Update Date : 06/10/2026

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