Individual
MR. KARIS LAVON JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
218 S 182ND EAST AVE, TULSA, OK 74108-2133
(918) 691-8579
Mailing address
218 S 182ND EAST AVE, TULSA, OK 74108-2133
(918) 691-8579
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
1194001412
OK
Other
Enumeration date
02/24/2012
Last updated
02/24/2012
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