Individual
MYRIAH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4806 N PERKINS RD, STILLWATER, OK 74075-1710
(405) 372-2913
Mailing address
309 W PINE AVE, ENID, OK 73701-3159
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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