Individual
SAMANTHA JO JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1613 SE 66TH ST, OKLAHOMA CITY, OK 73149-5203
(405) 616-3366
Mailing address
2063 W LINDSEY ST APT G, NORMAN, OK 73069-4130
(405) 616-3366
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0048019
OK
Other
Enumeration date
11/20/2025
Last updated
11/20/2025
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