INGRID W. JACKSON M.D. LLC NPI 1205336187

NPI Information

  • NPI: 1205336187
  • Provider Name: INGRID W. JACKSON, M.D., LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: FAITH FAMILY HEALTHCARE CLINIC
  • CLIA Number: 37D2174035
  • Address: 740 SIGNAL RIDGE DR
    EDMOND, OK
    ZIP 73013
  • Phone: (405) 418-0125

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NPI Details

INGRID W. JACKSON, M.D., LLC is a family medicine in Edmond, OK. The provider is 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. INGRID W. JACKSON, M.D., LLC NPI is 1205336187. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Faith Family Healthcare Clinic.

The provider's business location address is:

740 SIGNAL RIDGE DR
EDMOND, OK
ZIP 73013-675
Phone: (405) 418-0125
Fax: (405) 216-3454

The provider's authorized official is Tina White .
The authorized official title is Owner and has the following contact phone number (405) 418-0125.

The CLIA number assigned to this NPI record is 37D2174035 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/16/2018 and was last updated on 10/28/2024.

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
1207Q00000XFamily Medicine15786OKLAHOMAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100220060MEDICAIDOKLAHOMA

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: 11/21/2025

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