Individual
SCOTTY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
34550 AIRLINE RD, PAULS VALLEY, OK 73075-9337
(405) 207-9238
(405) 207-9240
Mailing address
34550 AIRLINE RD, PAULS VALLEY, OK 73075-9337
(405) 207-9238
(405) 207-9240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
211329
OK
363LF0000X
Family Nurse Practitioner
R0078720
OK
Other
Enumeration date
01/11/2023
Last updated
07/11/2023
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