Individual
KACIE LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
312 N VAN BUREN ST, ENID, OK 73703-4500
(888) 573-7792
Mailing address
115 E DOGWOOD DR, POND CREEK, OK 73766-9788
(405) 570-7523
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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