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Contact Information

KEVIN T JACKSON
310 S 49TH W AVE
TULSA, OK74127
 Phone: 918-813-9699
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Mental Health

101YM0800X
Indicates primary specialty

NPI Profile & details for KEVIN T JACKSON · (Male)

NPI Number 1114456498
Status Active
Credentials
Entity Individual
Enumeration date 06/08/2017
Last updated 06/08/2017 - About 9 years ago
Sole proprietor 1 Yes
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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