DEETRA JACKSON (NPI# 1326485582) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326485582 |
| Entity Type | Individual |
| Full Name | DEETRA JACKSON |
| Practice Address |
411 S Central Ave Idabel OK 74745-6059 |
| Mailing Address |
107 S High St Antlers OK 74523-3818 |
| Practice Telephone | 5802865045 |
| Practice Fax Number | 5802865721 |
| Mailing Telephone | 5802982830 |
| Mailing Fax Number | 5802986723 |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2013-05-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
411 S CENTRAL AVE |
| City | IDABEL |
| State | OK |
| Zip Code | 74745-6059 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740344290 | Sequelcare of Oklahoma, LLC | Clinic/Center | 411 S Central Ave, Idabel, OK 74745-6059 | 2006-12-20 |
| 1912506254 | Kara Olfert | Social Worker | 411 S Central Ave, Idabel, OK 74745-6059 | 2020-10-19 |
| 1184197626 | Dayna Natasha Erickson | Health Educator | 411 S Central Ave, Idabel, OK 74745-6059 | 2019-01-08 |
| 1184109902 | Amber Clarice Bond | Health Educator | 411 S Central Ave, Idabel, OK 74745-6059 | 2018-09-27 |
| 1134604945 | Kimberly Rose Battiest | Licensed Practical Nurse | 411 S Central Ave, Idabel, OK 74745-6059 | 2018-09-27 |
| 1922583863 | Samantha Lynn Burke | Case Manager/Care Coordinator | 411 S Central Ave, Idabel, OK 74745-6059 | 2018-09-26 |
| 1538653126 | Marisa Mullins | Case Manager/Care Coordinator | 411 S Central Ave, Idabel, OK 74745-6059 | 2018-06-18 |
| 1871080424 | Ann Marie Treser-stephens | Counselor | 411 S Central Ave, Idabel, OK 74745-6059 | 2018-04-19 |
| 1871000877 | Tina Marie Clark | Peer Specialist | 411 S Central Ave, Idabel, OK 74745-6059 | 2017-12-29 |
| 1164947024 | Toya Robbins | Health Educator | 411 S Central Ave, Idabel, OK 74745-6059 | 2017-08-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568957348 | Home Run Healthcare | Family Medicine | 1425 East Lincoln Road, Suite A-3, Idabel, OK 74745 | 2018-06-25 |
| 1720457203 | Leann Tomlinson | Registered Nurse | 2002 E Lincoln Rd, Idabel, OK 74745 | 2015-09-15 |
| 1659795508 | Laura Rush | Optometrist | 902 Lincoln Road, Idabel, OK 74745 | 2014-02-13 |
| 1619301116 | White River Home Health | Home Health | 2100 East Washington Street Ste D, Idabel, OK 74745 | 2013-09-03 |
| 1922440999 | John Phillip Stone Scoggin | Counselor | 111 Canterbury Lane, Idabel, OK 74745 | 2013-07-19 |
| 1841576725 | Ayesha Shante Wyatt | Nurse's Aide | 1800 Hillcrest, Idabel, OK 74745 | 2011-10-24 |
| 1154569457 | Southern Oklahoma Treatment Services, Inc. | Community/Behavioral Health | 6 Southeast Avenue A, Idabel, OK 74745 | 2009-01-26 |
| 1417103854 | John Hoskins | Internal Medicine | 902 Lincoln Rd, Choctaw Nation Health Clinic, Idabel, OK 74745 | 2008-08-18 |
| 1801077045 | Rhonda Cheryl Rodgers | Counselor | 104 Ne Ave A, Idabel, OK 74745 | 2007-11-15 |
| 1326241548 | Beverly Gayle Jasper-hayes | Counselor | 104 Ne A - Avenue, Idabel, OK 74745 | 2007-06-06 |
| Find all providers in zip 74745 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730522988 | Latoya Savon James | Counselor | 1303 S Lynn Ln, Idabel, OK 74745-6845 | 2013-04-08 |
| 1699050534 | Courtney L Nolen | Counselor | 1301 Se Washington St, Idabel, OK 74745-3445 | 2011-10-11 |
| 1376827287 | Charlain D Griffin | Counselor | 1310 Se Washington St, Idabel, OK 74745-3446 | 2011-10-11 |
| 1497945828 | Kristi Fulmer | Counselor | 403 Redbird Dr, Idabel, OK 74745-3718 | 2007-08-01 |
| 1326241548 | Beverly Gayle Jasper-hayes | Counselor | 104 Ne A - Avenue, Idabel, OK 74745 | 2007-06-06 |
| 1275974479 | Hodges Perkins | Counselor | 1310 Se Washington St, Idabel, OK 74745-3446 | 2013-07-16 |
| 1083053003 | Kristy Woolsey | Counselor | 1310 Se Washington St, Idabel, OK 74745-3446 | 2013-06-24 |
| 1205272077 | Cynthia Perkins | Counselor | 1310 Se Washington St, Idabel, OK 74745-3446 | 2013-05-20 |
| 1023373453 | Tina Simer | Counselor | 17 S Central Ave, Idabel, OK 74745-4625 | 2012-07-11 |
| 1154686160 | Lashay Mickle Sims | Counselor | 17 S Central Ave, Idabel, OK 74745-4625 | 2012-07-06 |
| Find all providers in IDABEL | ||||
Please comment or provide details below to improve the information on DEETRA JACKSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.