Organization
PAULS VALLEY FAMILY HEALTHCARE APRN FNP-BC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTTY EUGENE JACKSON APRN-FNP-BC (NURSE PRACTITIONER / OWNER)
(405) 207-9238
Entity
Organization
Contact information
Practice address
34550 AIRLINE RD, PAULS VALLEY, OK 73075-9337
(405) 207-9238
(405) 207-9240
Mailing address
34550 AIRLINE RD, PAULS VALLEY, OK 73075-9337
(405) 207-9238
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
211329
OKLAHOMA STATE BOARD OF NURSING
OK
Enumeration date
02/09/2023
Last updated
04/20/2023
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