ELISSA NACOLE JACKSON RESIDENT ASSISTANT NPI 1104587401

NPI Information

NPI: 1104587401
Provider Name: ELISSA NACOLE JACKSON, RESIDENT ASSISTANT
Classification: Counselor - 101YM0800X
Entity Type: Individual

Specialization: Mental Health

Address:
1719 E 27TH ST N
TULSA, OK
ZIP 74110
Phone: (918) 982-7687
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Elissa Nacole Jackson, RESIDENT ASSISTANT is a mental health counselor in Tulsa, OK. Elissa Nacole Jackson, RESIDENT ASSISTANT NPI is 1104587401. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1719 E 27TH ST N
TULSA, OK
ZIP 74110-705
Phone: (918) 982-7687

The enumeration date for this NPI number is 1/7/2022 and was last updated on 1/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health		OKLAHOMA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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