Provider Demographics
NPI:1710267752
Name:BURGESS-JACKSON, WHITNEY NICHOLE
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:NICHOLE
Last Name:BURGESS-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 HUNTSMAN RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3526
Mailing Address - Country:US
Mailing Address - Phone:918-440-6970
Mailing Address - Fax:
Practice Address - Street 1:1805 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-6140
Practice Address - Country:US
Practice Address - Phone:918-440-6970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical