Individual
BREYAN LASHAWN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3606 N MLK JR. BLVD, TULSA, OK 74106
(918) 949-4212
(918) 949-4299
Mailing address
3606 N MLK JR. BLVD, TULSA, OK 74106
(918) 949-4212
(918) 949-4299
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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