Individual
CORTNEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
SIOC 1624 CIMARRON PLAZA, STILLWATER, OK 74075-3467
(405) 338-7072
Mailing address
SIOC 1624 CIMARRON PLAZA, STILLWATER, OK 74075-3467
(405) 338-7072
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
K082948200
OK
Other
Enumeration date
11/05/2019
Last updated
12/05/2019
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