Individual
TIFFANIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
308 SW 25TH ST, OKLAHOMA CITY, OK 73109-5922
(405) 470-8778
Mailing address
725 PALMER DR, MIDWEST CITY, OK 73110-8155
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/03/2015
Last updated
11/03/2015
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