Individual
MS. KYNDRA ASHANTA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4301 MOW-WAY ROAD, REYNOLDS ACH (ATTN: MCUA-QC, MS. PRESCOTT), FORT SILL, OK 73503-6300
(580) 458-2134
(580) 458-2314
Mailing address
4301 MOW-WAY ROAD, REYNOLDS ACH (ATTN: MCUA-QC, MS. PRESCOTT), FORT SILL, OK 73503-6300
(580) 458-2134
(580) 458-2314
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R153354
MD
Other
Enumeration date
09/13/2006
Last updated
07/08/2007
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