Individual
MICHALLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
602 COLONY DR, SAND SPRINGS, OK 74063-7428
(417) 818-4821
Mailing address
PO BOX 1588, SAND SPRINGS, OK 74063-1588
(417) 818-4821
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OK
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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