Individual
KYLEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, ATC, LAT
Contact information
Practice address
300 N EASTERN AVE, MOORE, OK 73160-6999
(405) 735-4700
Mailing address
9501 S I 35 SERVICE RD APT 820, MOORE, OK 73160-3150
(918) 851-7748
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
888
OK
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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