PAULS VALLEY FAMILY HEALTHCARE APRN FNP-BC LLC
NPI 1407553597
Clinic/Center - Primary Care in Pauls Valley, OK
About Pauls Valley Family Healthcare Aprn Fnp-bc Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PAULS VALLEY FAMILY HEALTHCARE APRN FNP-BC LLC (NPI 1407553597) is a healthcare organization registered as a primary care in Pauls Valley, Oklahoma and active in the NPI registry since February 2023. The organization holds a CLIA Waiver certificate valid through September 15, 2027 and lists Scotty Eugene Jackson, Nurse Practitioner / Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Pauls Valley Family Healthcare Aprn Fnp-bc Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Pauls Valley Family Healthcare Aprn Fnp-Bc LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 37D2277996
Pauls Valley Family Healthcare Aprn, Fnp-Bc · Pauls Valley, OKFrequently 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 Pauls Valley Family Healthcare Aprn Fnp-Bc LLC's NPI number?
The NPI number for Pauls Valley Family Healthcare Aprn Fnp-Bc LLC is 1407553597. It was assigned to this organization in the NPPES registry on February 9, 2023.
Where is Pauls Valley Family Healthcare Aprn Fnp-Bc LLC located?
Pauls Valley Family Healthcare Aprn Fnp-Bc LLC is located at 34550 Airline Rd, Pauls Valley, OK 73075. The listed phone number is (405) 207-9238.
What is Pauls Valley Family Healthcare Aprn Fnp-Bc LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Pauls Valley Family Healthcare Aprn Fnp-Bc LLC enrolled in Medicare?
Yes. Pauls Valley Family Healthcare Aprn Fnp-Bc LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Pauls Valley Family Healthcare Aprn Fnp-Bc LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Pauls Valley Family Healthcare Aprn Fnp-Bc LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Pauls Valley Family Healthcare Aprn Fnp-Bc LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 37D2277996) is associated with this NPI, valid through September 15, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Pauls Valley Family Healthcare Aprn Fnp-Bc LLC was last updated on April 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# Pauls Valley Family Healthcare Aprn Fnp-Bc Llc · NPI 1407553597
Primary Care organization in Pauls Valley, Oklahoma. Organization record, active in the CMS NPPES registry since February 9, 2023.
## Identity
- **NPI:** 1407553597 (Entity type: Organization)
- **Enumerated:** February 9, 2023
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Scotty Jackson, NURSE PRACTITIONER / OWNER
## Practice location
- **Address:** 34550 AIRLINE RD, Pauls Valley, OK 73075-9337
- **Phone:** (405) 207-9238 · **Fax:** (405) 207-9240
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 20, 2023
- **Other identifiers:** Other 211329 (OK)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1407553597) · Data from the CMS NPPES public registry.