Individual
RAYNISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4907 S 73RD EAST AVE UNIT 4, TULSA, OK 74145-6741
(305) 713-2623
Mailing address
4907 S 73RD EAST AVE UNIT 4, TULSA, OK 74145-6741
(305) 713-2623
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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