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Contact Information

EBONY T JACKSON, CLTC, CHHA, CCNA
5930 E 31ST ST STE 550
TULSA, OK74135-5121
 Phone: 918-313-9591
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
 

Gerontology

364SG0600X 89 Certified Clinical Nurse Specialist
 

Health & Wellness Coach

171400000X
 

In Home Supportive Care

253Z00000X
 

Long-Term Care

364SL0600X 89 Certified Clinical Nurse Specialist
Indicates primary specialty

NPI Profile & details for EBONY T JACKSON · (Female)

NPI Number 1588328637
Status Active
Credentials CLTC, CHHA, CCNA
Entity Individual
Enumeration date 10/25/2021
Last updated 10/25/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • OK License # 37V954550119
  • OK License # 37V954560119
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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