Jackson, Kendrick

Jackson, Kendrick is an sole proprietor health care provider with primary practice located at 2501 Ne 15Th St , Oklahoma City OK 73117-5224. He recently has only one registered license in Behavioral Health & Social Service Providers / Counselor, which is considered as his primary health care specialty. Jackson, Kendrick can be contacted via phone (405) 706-4537.

Contact Information

Primary practice address
2501 Ne 15Th St Oklahoma City OK 73117-5224
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1679826747
LBN Legal business name Jackson, Kendrick
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 25th, 2012
Last updated Oct 25th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679826747 NPPES
Oklahoma MEDICAID 200287120A

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