Individual
TOHNYONAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7500 KNIGHT LAKE DR APT 123, OKLAHOMA CITY, OK 73132-6019
(405) 339-6369
Mailing address
7500 KNIGHT LAKE DR APT 123, OKLAHOMA CITY, OK 73132-6019
(405) 339-6369
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
OK
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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