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JORDAN TYLER JACKSON MEDICAL STUDENT
NPI 1891315222
Student in an Organized Health Care Education/Training Program in Edmond, OK

Active since April 27, 2020
19512 CREST RIDGE DR, EDMOND, OK 73012(918) 367-8128 Get Directions Write a Review

NPPES record last updated: April 27, 2020. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Jordan Tyler Jackson Medical Student NPPES

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

JORDAN TYLER JACKSON MEDICAL STUDENT (NPI 1891315222) is an individual student in an organized health care education/training program in Edmond, Oklahoma and active in the NPI registry since April 2020.

NPPES Registry Identity

NPI1891315222
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJORDAN TYLER JACKSONCredential: MEDICAL STUDENT
Location Address19512 CREST RIDGE DREdmond, OK 73012-3504
Mailing Address19512 Crest Ridge DrEdmond, OK 73012-3504 · (918) 367-8128
Phone(918) 367-8128
Sole ProprietorNo
Enumeration DateApril 27, 2020
NPPES CertifiedApril 27, 2020
✔ NPI 1891315222 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
19512 CREST RIDGE DR, Edmond, OK 73012
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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 Jordan Jackson's NPI number?

The NPI number for Jordan Jackson is 1891315222. It was assigned to this individual provider in the NPPES registry on April 27, 2020.

Where is Jordan Jackson located?

Jordan Jackson practices at 19512 Crest Ridge Dr, Edmond, OK 73012. The listed phone number is (918) 367-8128.

What is Jordan Jackson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Jordan Jackson was last updated on April 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.