INGRID W. JACKSON MD (NPI# 1205336187) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205336187 |
| Entity Type | Organization |
| Organization Name | INGRID W. JACKSON MD |
| Other Organization Name | INGRID W JACKSON MD LLC |
| Practice Address |
609 W Memorial Rd Oklahoma City OK 73114-2006 |
| Mailing Address |
12101 N Macarthur Blvd. Suite A#105 Oklahoma City OK 73162-1800 |
| Practice Telephone | 4054180125 |
| Mailing Telephone | 4054180125 |
| Mailing Fax Number | 4054185404 |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2019-06-29 |
| Authorized Official Name | DR. INGRID W. JACKSON (OWNER) |
| Authorized Official Telephone | 4054737927 |
| Authorized Official Credential | MEDICAL DOCTOR |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 15786 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100220060 | 05 |
| Other Name | Type Code |
|---|---|
| INGRID W JACKSON MD LLC | Doing Business As Name - Organization |
| Street Address |
609 W MEMORIAL RD |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73114-2006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548269459 | Darren Dean Elenburg | Podiatrist | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2005-07-21 |
| 1205476819 | Saints Medical Group, LLC | Family Medicine | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2020-01-11 |
| 1053961185 | Morgan Eyecare, Pllc | Clinic/Center | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2019-09-20 |
| 1265992978 | All Things Through Christ, LLC | Family Medicine | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2019-03-20 |
| 1609331891 | Onesource Practitioners, LLC | Family Medicine | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2019-02-01 |
| 1821561770 | Karen Brown | Nurse Practitioner | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2019-01-03 |
| 1407355324 | Hebrewselevenone LLC | Pediatrics | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2018-02-06 |
| 1467950519 | Kimberly Bryan | Family Medicine | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2018-01-24 |
| 1174057624 | Chad Michael Knight | Podiatrist | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2017-04-11 |
| 1720449598 | Frey Orthopedics, Pllc | Orthopaedic Surgery | 609 W Memorial Rd, Oklahoma City, OK 73114-2006 | 2016-03-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124669783 | Heather Williams | Occupational Therapist | 1404 Nw122nd St, Oklahoma City, OK 73114 | 2019-10-04 |
| 1477194033 | Shonta Jones | Technician | 10723 Norh Western, Apartment G, Oklahoma City, OK 73114 | 2019-10-04 |
| 1023537644 | Tracye Carter | Registered Nurse | 812 Nw 121 Terr, Oklahom City, OK 73114 | 2017-09-14 |
| 1003362849 | Randy Joshua Williamson | Behavioral Analyst | 101 Bainbridge Rd, Oklahoma City, OK 73114 | 2016-08-31 |
| 1427413368 | John Adrian Howard | Physical Therapist | 13100 N Western Ave Ste 302, Oklahoma City, OK 73114 | 2015-12-18 |
| 1497150197 | Payam Ishani Afousi | Dentist | 9405 N. Penn Place, Casady Square, Oklahoma City, OK 73114 | 2014-10-24 |
| 1922407386 | Kelvin Hughes | Counselor | 1400 Nw 105th Ter, Oklahoma City, OK 73114 | 2014-08-21 |
| 1285056887 | Malarie Jackson | Nurse Practitioner | 609 W. Memorial Rd., Oklahoma City, OK 73114 | 2014-01-16 |
| 1508108705 | Adam Liberty | Community/Behavioral Health | 428 N.w 81st, Oklahoma City, OK 73114 | 2013-03-26 |
| 1780926345 | Michelle D Hardimon | Behavioral Analyst | 700 Ne 122nd Apt 4509, Oklahoma City, OK 73114 | 2013-03-21 |
| Find all providers in zip 73114 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039632 | Axiom Medical Solutions, LLC | Family Medicine | 14132 Se 134th St, Oklahoma City, OK 73165-7669 | 2020-09-28 |
| 1104437219 | L and M Investments LLC | Family Medicine | 6001 Nw 139th St, Oklahoma City, OK 73142-1919 | 2020-08-12 |
| 1235748617 | Brook Noel Leland | Family Medicine | 3329 Nw 22nd St, Oklahoma City, OK 73107-3021 | 2020-07-30 |
| 1043835176 | Thomas Patrick Owens IIi | Family Medicine | 900 Ne 10th Street, Oklahoma City, OK 73104-5420 | 2020-06-15 |
| 1730703562 | Michael Williamson | Family Medicine | 3500 Nw 56th St Ste 10, Oklahoma City, OK 73112-4529 | 2020-06-08 |
| 1295363620 | Saint Medical Group, LLC | Family Medicine | 3400 S Douglas Blvd Ste 307, Oklahoma City, OK 73150-1001 | 2020-03-31 |
| 1881220580 | Sarah Laing | Family Medicine | 1111 N Lee Ave Ste 305, Oklahoma City, OK 73103-2620 | 2020-03-14 |
| 1881225290 | Neans Lynn Denson | Family Medicine | 2815 Sw 119th St, Oklahoma City, OK 73170-2605 | 2020-02-04 |
| 1114563699 | Aim Health Clinics, LLC | Family Medicine | 2301 W I 44 Service Rd Ste 310, Oklahoma City, OK 73112-8729 | 2019-11-20 |
| 1841843265 | Stephanie N White | Family Medicine | 3400 Nw Expressway Bldg C-815, Oklahoma City, OK 73112-4493 | 2019-07-24 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.