OrganizationActive
Jackson Medical Clinic, PC
NPI 1457594699 · General Practice Physician · Wagoner, OK
Provider details
- NPI number
- 1457594699
- Entity type
- Organization
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Kelly Haley, Office Manager(918) 485-5591
- License
- 28153 (OK)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
410 E Cherokee St
Wagoner, OK 74467-4708
Phone: (918) 485-5591
Fax: (918) 485-5758
Approximate (ZIP-level) locationGet directions
Mailing address
410 E Cherokee St
Wagoner, OK 74467-4708
Other names (DBA / former)
- Former legal business name
- Jackson Family Clinic
Registry dates
- Enumerated
- 2009-04-17
- Last updated
- 2017-03-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.