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JACKSON MEDICAL CLINIC, PC
NPI 1457594699
General Practice in Wagoner, OK

Active since April 17, 2009
410 E CHEROKEE ST, WAGONER, OK 74467(918) 485-5591(918) 485-5758 Get Directions Write a Review

NPPES record last updated: March 22, 2017. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jackson Medical Clinic, Pc NPPES

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

JACKSON MEDICAL CLINIC, PC (NPI 1457594699), doing business as Jackson Family Clinic, is a healthcare organization registered as a general practice in Wagoner, Oklahoma and active in the NPI registry since April 2009. The organization lists Kelly Noel Haley, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1457594699
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameJACKSON MEDICAL CLINIC, PC
Location Address410 E CHEROKEE STWagoner, OK 74467-4708
Mailing Address410 E Cherokee StWagoner, OK 74467-4708 · (918) 485-5591 · Fax (918) 485-5758
Phone(918) 485-5591
Fax(918) 485-5758
Organization SubpartNo
Authorized OfficialKelly Noel HaleyOffice Manager · (918) 485-5591
Enumeration DateApril 17, 2009
Last NPPES UpdateMarch 22, 2017
✔ NPI 1457594699 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in OK · 28153
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
410 E CHEROKEE ST, Wagoner, OK 74467
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Other Names 1

Former Legal Business NameJackson Family Clinic

Other Identifiers 3

Medicare NSC0818240001OK
Medicaid100141080EOK
Medicare PIN450705149OK

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

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

DR. MICHAEL DOUGLAS GORMAN MD
Family Medicine
410 E CHEROKEE ST
WAGONER, OK 74467
Wagoner County (918) 485-5591
JOHN CLAUDE JACKSON D.O.
Family Medicine
410 E CHEROKEE ST
WAGONER, OK 74467
Wagoner County (918) 485-5591

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 Medical Clinic, PC's NPI number?

The NPI number for Jackson Medical Clinic, PC is 1457594699. It was assigned to this organization in the NPPES registry on April 17, 2009. The provider was formerly known as Jackson Family Clinic.

Where is Jackson Medical Clinic, PC located?

Jackson Medical Clinic, PC is located at 410 E Cherokee St, Wagoner, OK 74467. The listed phone number is (918) 485-5591.

What is Jackson Medical Clinic, PC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

When was this NPI record last updated?

The NPPES record for Jackson Medical Clinic, PC was last updated on March 22, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.