SCOTTY JACKSON FNP-BC NPI 1750095980

NPI Information

  • NPI: 1750095980
  • Provider Name: SCOTTY JACKSON, FNP-BC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 34550 AIRLINE RD
    PAULS VALLEY, OK
    ZIP 73075
  • Phone: (405) 207-9238

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NPI Details

Scotty Jackson, FNP-BC is a family nurse practitioner in Pauls Valley, OK with 4 years of experience. Scotty Jackson, FNP-BC NPI is 1750095980. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

34550 AIRLINE RD
PAULS VALLEY, OK
ZIP 73075-337
Phone: (405) 207-9238
Fax: (405) 207-9240

The NPI 1750095980 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/11/2023 and was last updated on 7/11/2023.

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
1363LF0000XNurse PractitionerFamilyR0078720OKLAHOMANo
2363LF0000XNurse PractitionerFamily211329OKLAHOMAYes

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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