Individual
MRS. JESSICA ELISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2109 S SANTA FE AVE, MOORE, OK 73160-2807
(405) 213-0256
Mailing address
12220 GREENLEA CHASE W, OKLAHOMA CITY, OK 73170-6010
(405) 761-3256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2725
OK
363A00000X
Physician Assistant
—
OK
Other
Enumeration date
12/28/2016
Last updated
01/16/2020
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