Individual
MARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5201 HARRY HINES BLVD, DALLAS, TX 75235-7708
(214) 590-8000
Mailing address
105 WALL ST, POTEAU, OK 74953-4433
(918) 635-3566
(918) 635-3308
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
132732
OK
363LA2100X
Acute Care Nurse Practitioner
AP127185
TX
Other
Enumeration date
02/12/2015
Last updated
09/03/2019
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