Individual
LATASHA SHERIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1200 N PHILLIPS AVE, OKLAHOMA CITY, OK 73104-4600
(405) 271-2244
Mailing address
8411 S BROOKLINE AVE, OKLAHOMA CITY, OK 73159-6420
(405) 271-2244
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
65726
OK
Other
Enumeration date
01/26/2016
Last updated
01/26/2016
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