Individual
JETTA ANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
702 NW SHERIDAN RD, LAWTON, OK 73505-5203
(580) 576-3376
(580) 576-3375
Mailing address
702 NW SHERIDAN RD, LAWTON, OK 73505-5203
(580) 576-3376
(580) 576-3375
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2764
OK
Other
Enumeration date
01/27/2017
Last updated
12/30/2025
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