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Individual

MRS. KACI LYNN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
6151 S YALE AVE STE 100A, TULSA, OK 74136-1929
(918) 494-8500
(918) 307-5578
Mailing address
6600 S YALE AVE STE 1400, TULSA, OK 74136-3331

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R0066985
OK
363LF0000X
Family Nurse Practitioner
R0066985
OK

Other

Enumeration date
12/31/2007
Last updated
10/26/2023
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