Provider Demographics
NPI:1215742135
Name:MCCARTER, JACKIE BARTON (APRN)
Entity type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:BARTON
Last Name:MCCARTER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:OK
Mailing Address - Zip Code:74730-1368
Mailing Address - Country:US
Mailing Address - Phone:903-416-4100
Mailing Address - Fax:
Practice Address - Street 1:312 S 3RD ST
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:OK
Practice Address - Zip Code:74730-1368
Practice Address - Country:US
Practice Address - Phone:580-775-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX907445163WE0003X
TX1192391363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency