Individual
SASA K JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1400 SE 4TH ST, STE H, MOORE, OK 73160-7329
(405) 799-7400
(405) 799-7405
Mailing address
1400 SE 4TH ST, STE H, MOORE, OK 73160-7329
(405) 799-7400
(405) 799-7405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2107
OK
Other
Enumeration date
01/20/2012
Last updated
01/20/2012
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