KENNETH C JACKSON M.D.
NPI 1457491037
Specialist in Warr Acres, OK

Q: What is Kenneth Jackson's NPI number?

The NPI number for Kenneth Jackson is 1457491037. It was assigned to this individual provider in the NPPES registry on February 6, 2007.

Q: What is Kenneth Jackson's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Q: When was this NPI record last updated?

The NPPES record for Kenneth Jackson was last updated on March 7, 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.

Active since February 06, 2007PECOS Enrolled

7301 N COMANCHE AVE, OU PHYSICIANS, WARR ACRES, OK 73132(405) 721-8090(405) 722-8529 Get Directions Write a Review

NPPES record last updated: March 7, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Kenneth C Jackson M.d. NPPES

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

KENNETH C JACKSON M.D. (NPI 1457491037) is an individual specialist in Warr Acres, Oklahoma, licensed in Oklahoma (11030) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1457491037

Entity TypeIndividualMale

Primary Taxonomy174400000X

Provider Legal NameKENNETH C JACKSONCredential: M.D.

Location Address7301 N COMANCHE AVE, OU PHYSICIANSWarr Acres, OK 73132-6646

Mailing Address7301 N Comanche AveWarr Acres, OK 73132-6646 · (405) 721-8090 · Fax (405) 722-8529

Phone(405) 721-8090

Fax(405) 722-8529

Sole ProprietorNo

Enumeration DateFebruary 6, 2007

Last NPPES UpdateMarch 7, 2023

✔ NPI 1457491037 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in OK · 11030

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

7301 N COMANCHE AVE, Warr Acres, OK 73132

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Other Identifiers 1

Other11030OK · License

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenneth C Jackson M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 12

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

GRAND PRAIRIE PEDIATRICS

Clinic/Center (Primary Care)