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Individual

MRS. EBONY TAMU JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CLTC, CHHA, CCNA

Contact information

Practice address
5930 E 31ST ST STE 550, TULSA, OK 74135-5121
(918) 313-9591
Mailing address
5930 E 31ST ST STE 550, TULSA, OK 74135-5121
(918) 313-9591

Taxonomy

Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
37V954550119
OK
174400000X
Specialist
Primary
37V954550119
OK
253Z00000X
In Home Supportive Care Agency
37V954560119
OK
364SG0600X
Gerontology Clinical Nurse Specialist
37V954550119
OK
364SL0600X
Long-Term Care Clinical Nurse Specialist
37V954550119
OK

Other

Enumeration date
10/25/2021
Last updated
10/25/2021
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