Individual
JACKIE J PARNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
607 S BROADWAY, COWETA, OK 74429-5000
(918) 486-5564
(918) 486-3284
Mailing address
15187 W GRANDVIEW RD, TAHLEQUAH, OK 74464-1118
(918) 316-2200
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
552
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100209620B
—
OK
Enumeration date
10/24/2005
Last updated
09/19/2012
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