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
Phone: (405) 706-4537
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679826747 | NPPES |
| Oklahoma | MEDICAID | 200287120A |
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