Most Relevant Information
Provider Data
NPI Number: | 1003509175 |
Provider Name: | RAYNISHA JACKSON |
Entity Type: | Individual |
Taxonomy Code: | 251B00000X |
Specialty: | Case Management |
License Number: |
Most Important Dates
Enumeration Date: | 06/02/2023 |
Last Updated: | 06/02/2023 |
Provider Practice Location
4907 S 73RD EAST AVE UNIT 4
TULSA
OK
741456741
Practice Location Phone/Fax
Phone: | 3057132623 |
Fax: |
Provider Mailing Location
4907 S 73RD EAST AVE UNIT 4
TULSA
OK
741456741
Provider Mailing Phone/Fax
Phone: | 3057132623 |
Fax: |