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Jackson Medical Clinic, PC

General Practice Physician in Wagoner, OK · enumerated 2009 · authorized official Kelly Haley, Office Manager.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1457594699

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Registry record

Entity type Organization (Type 2)
Legal business name Jackson Medical Clinic, PC
Other name <Unavail>
Practice address 410 E Cherokee St, Wagoner, OK, 74467
Phone (918) 485-5591
Fax (918) 485-5758
Enumeration date Apr 17, 2009
Last updated in NPPES Mar 22, 2017

Taxonomy & classification

208D00000X General Practice Physician Allopathic & Osteopathic Physicians · License 28153 (OK) Primary

Authorized official

Name Kelly Haley
Title Office Manager
Phone (918) 485-5591

Other identifiers

Identifier Type State Issuer
100141080E Medicaid OK -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Jackson Medical Clinic, PC?
NPPES lists Kelly Haley (Office Manager) as the authorized official for this organization.
What is the NPI number for Jackson Medical Clinic, PC?
The NPI for Jackson Medical Clinic, PC is 1457594699, a Type 2 (organization) record in the CMS NPPES registry.

Providers at this address

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2017-03-22.