Individual
LISA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
436 COURT ST STE B, MUSKOGEE, OK 74401-6303
(918) 869-3063
Mailing address
436 COURT ST STE B, MUSKOGEE, OK 74401-6303
(918) 869-3063
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/22/2025
Last updated
05/22/2025
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