Provider Demographics
NPI:1528542081
Name:JACKSON, JOYCEALYN KAYE
Entity Type:Individual
Prefix:
First Name:JOYCEALYN
Middle Name:KAYE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCEALYN
Other - Middle Name:KAYE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15500 JEFFERSONS GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1410
Mailing Address - Country:US
Mailing Address - Phone:405-330-8200
Mailing Address - Fax:
Practice Address - Street 1:15500 JEFFERSONS GARDEN CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1410
Practice Address - Country:US
Practice Address - Phone:405-330-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator