Individual
JACKIE JENE ODELL-MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
5604 SW LEE BLVD STE 357, LAWTON, OK 73505-9663
(580) 699-8020
(580) 699-8060
Mailing address
5604 SW LEE BLVD STE 357, LAWTON, OK 73505-9663
(580) 699-8020
(580) 699-8060
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0044689
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100070A
—
OK
01
—
R0044689
STATE LICENSE NUMBER
OK
Enumeration date
11/29/2006
Last updated
12/22/2025
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