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MR. JACKSON DAVIS PHELPS LPN
NPI 1336954569
Licensed Practical Nurse in Shawnee, OK

Active since February 13, 2025
781 GRAND CASINO BLVD, SHAWNEE, OK 74804(405) 964-5770(405) 695-6029 Get Directions Write a Review

NPPES record last updated: February 13, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Jackson Davis Phelps Lpn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACKSON DAVIS PHELPS LPN (NPI 1336954569) is an individual licensed practical nurse in Shawnee, Oklahoma, licensed in Oklahoma (219424) and active in the NPI registry since February 2025.

NPPES Registry Identity

NPI1336954569
Entity TypeIndividualMale
Primary Taxonomy164W00000X
Provider Legal NameMR. JACKSON DAVIS PHELPSCredential: LPN
Location Address781 GRAND CASINO BLVDShawnee, OK 74804-1005
Mailing Address781 Grand Casino BlvdShawnee, OK 74804-1005 · (405) 964-5770 · Fax (405) 695-6029
Phone(405) 964-5770
Fax(405) 695-6029
Sole ProprietorNo
Enumeration DateFebruary 13, 2025
NPPES CertifiedFebruary 13, 2025
✔ NPI 1336954569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in OK · 219424
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
781 GRAND CASINO BLVD, Shawnee, OK 74804
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MISS MARY E ZIENTEK RN
Registered Nurse (Ambulatory Care)
781 GRAND CASINO BLVD, CITIZEN POTAWATOMI NATION HEALTH SERVICES
SHAWNEE, OK 74804
Pottawatomie County (405) 964-5770
JORDAN BENSON
Physical Therapist
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 695-6004
DUSTIN ALLEN MILLER
Registered Nurse
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 424-1517
NICOLE BROWN
Licensed Practical Nurse
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 964-5770
JESSICA WILLIAMS LPN
Licensed Practical Nurse
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 964-5770
MRS. DESTINY RUOSA MITCHELL APRN-CNP
Nurse Practitioner (Family)
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 964-5770
STACEY ANN CORNEIL RN
Registered Nurse
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 695-6003
TIFFANY SCHNEPPER LPN
Licensed Practical Nurse
781 GRAND CASINO BLVD
SHAWNEE, OK 74804
Pottawatomie County (405) 716-1716

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jackson Phelps's NPI number?

The NPI number for Jackson Phelps is 1336954569. It was assigned to this individual provider in the NPPES registry on February 13, 2025.

Where is Jackson Phelps located?

Jackson Phelps practices at 781 Grand Casino Blvd, Shawnee, OK 74804. The listed phone number is (405) 964-5770.

What is Jackson Phelps's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Jackson Phelps was last updated on February 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.