Individual
KIMETHRIA LAURIE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MSN, ARNP
Contact information
Practice address
1201 ARLINGTON ST, SUITE B, ADA, OK 74820-4072
(580) 436-1526
(580) 436-1354
Mailing address
1201 ARLINGTON ST, SUITE B, ADA, OK 74820-4072
(580) 436-1526
(580) 436-1354
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R0046831
OK
Other
Enumeration date
06/05/2006
Last updated
07/09/2007
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