Organization
GRAND PRAIRIE PEDIATRIC AND ALLERGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH C JACKSON MD (PRESIDENT)
(405) 721-8090
Entity
Organization
Contact information
Practice address
7301 N COMANCHE AVE, WARR ACRES, OK 73132-6646
(405) 721-8090
(405) 722-8529
Mailing address
7301 N COMANCHE AVE, WARR ACRES, OK 73132-6646
(405) 721-8090
(405) 722-8529
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
OK
Other
Enumeration date
01/16/2007
Last updated
07/21/2022
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