Organization
INGRID W. JACKSON, M.D., LLC
Active
Other names
Faith Family Healthcare Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TINA WHITE (OWNER)
(405) 418-0125
Entity
Organization
Contact information
Practice address
740 SIGNAL RIDGE DR, EDMOND, OK 73013-3675
(405) 418-0125
(405) 216-3454
Mailing address
740 SIGNAL RIDGE DR, EDMOND, OK 73013-3675
(405) 418-0125
(405) 216-3454
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15786
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100220060
—
OK
Enumeration date
02/16/2018
Last updated
10/28/2024
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