Provider Demographics
NPI:1821751991
Name:JACKSON, JANET ANN (DNP, APRN-CNS, CCRN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DNP, APRN-CNS, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 W VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6137
Mailing Address - Country:US
Mailing Address - Phone:918-645-5166
Mailing Address - Fax:
Practice Address - Street 1:3540 E 31ST ST STE 3
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1526
Practice Address - Country:US
Practice Address - Phone:918-749-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0049750364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty