Individual
MR. JACKSON DAVIS PHELPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 695-6029
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 695-6029
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
219424
OK
Other
Enumeration date
02/13/2025
Last updated
02/13/2025
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