Individual
SA'RITA CHERAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1404 NE 14TH ST, OKLAHOMA CITY, OK 73117-2021
(405) 201-1604
Mailing address
4600 WOODLAND PARK TER, SPENCER, OK 73084-2738
(405) 201-1604
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
04/09/2013
Last updated
04/09/2013
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