DEZJUAN VONTE JACKSON


Address: 10461 N May Ave, Oklahoma City, OK 73120-2610
Phone: 4055436314

DEZJUAN VONTE JACKSON (NPI# 1679073183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1679073183
Entity Type Individual
Full Name DEZJUAN VONTE JACKSON
Practice Address 10461 N May Ave
Oklahoma City
OK 73120-2610
Practice Telephone 4055436314
Mailing Telephone 4055436314
Enumeration Date 2018-02-20
Last Update Date 2018-02-20
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 332B00000X Durable Medical Equipment & Medical Supplies Suppliers
Y 335E00000X Prosthetic/Orthotic Supplier 314007 OK Suppliers

Office Location

Street Address 10461 N MAY AVE
City OKLAHOMA CITY
State OK
Zip Code 73120-2610

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1134768971 Nuvail Medical Services Inc In Home Supportive Care 3140 West Britton Road, Suite A, Oklahoma City, OK 73120 2019-12-26
1134781677 Peak Solutions, LLC Clinic/Center 12401 Trail Oaks Drive, Therapy Room, 2nd Floor, Oklahoma City, OK 73120 2019-07-05
1992363881 Laura Lynn's Home Care, LLC Home Health 9801 N May Ave, Oklahoma City, OK 73120 2019-06-05
1962992115 Erin Lyn Florer Occupational Therapist 12401 Trail Oak Dr, Oklahoma City, OK 73120 2018-05-14
1780171009 Diabetic Foot and Wound Center of Okfas Podiatrist 11100 Hefner Pointe Drive, Suite A, Oklahoma City, OK 73120 2018-04-23
1285134387 Motley Vision Professionals, Pllc Eyewear Supplier (Equipment, not the service) 9805 N. May Avenue, Oklahoma City, OK 73120 2018-02-15
1043729700 Jenna Marie Howard Social Worker 3301 North Meridian Ave., Building 100, Oklahoma City, OK 73120 2017-09-26
1962928895 Susan Chacko Counselor 12000 N Virginia Avenue, Oklahoma City, OK 73120 2017-08-22
1023533262 Farris Ree Stroupe Audiologist 4140 W. Memorial Rd Suite 116, Oklahoma City, OK 73120 2017-08-09
1881116200 Rebekah Danielle Kabariti Counselor 12000 N. Virgnia Ave, Oklahoma City, OK 73120 2017-07-07
Find all providers in zip 73120

Taxonomy Information

Taxonomy Code 335E00000X
Grouping Suppliers
Classification Prosthetic/Orthotic Supplier

Taxonomy Definition

An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1619515541 Lamoor Beauty Supply Prosthetic/Orthotic Supplier 2214 N Martin Luther King Ave, Oklahoma City, OK 73111-2404 2019-12-10
1598258378 Otto Bock Orthopedic Services LLC Prosthetic/Orthotic Supplier 5601 Nw 72nd Street, Suite 257, Oklahoma City, OK 73132-5920 2018-06-07
1639577885 La Fuente Prosthetics Prosthetic/Orthotic Supplier 229 N.w. 9th Street, Oklahoma City, OK 73102 2014-12-19
1881937977 Celerity Prosthetics, LLC Prosthetic/Orthotic Supplier 8625 S Walker Ave, Oklahoma City, OK 73139-9462 2013-03-27
1427376193 Genuine Care Rehabilitation Service Inc. Prosthetic/Orthotic Supplier 7510 Broadway Ext, Suite 204, Oklahoma City, OK 73116-9031 2010-05-05
1942490784 Hi Fashion Wigs LLC Prosthetic/Orthotic Supplier 1133 North May Ave. Ss, Oklahoma City, OK 73107-5335 2007-07-27
1164551479 Hair2wear, LLC Prosthetic/Orthotic Supplier 11624 Willow Way, Oklahoma City, OK 73162-2046 2007-03-04
1740366210 Revelation Enterprises Inc Prosthetic/Orthotic Supplier 2122 W Reno Ave, Oklahoma City, OK 73107-7028 2006-10-27
1124075833 Scott Sabolich Prosthetic & Research LLC Prosthetic/Orthotic Supplier 10201 Broadway Ext, Oklahoma City, OK 73114-6217 2006-05-28
1881672707 Compton Shoe Inc Prosthetic/Orthotic Supplier 3703 Nw 50th St, Oklahoma City, OK 73112-2553 2006-01-03
Find all providers in OKLAHOMA CITY

Competitor

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City OKLAHOMA CITY
Zip Code 73120

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Dataset Information

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.

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