Vivian Jackson

NPI #1164804563 in Atoka, Oklahoma

Provider Information

NPI Number: 1164804563
Entity Type: Individual
Name: Vivian Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Jun 22, 2015
Last Updated: Jun 22, 2015

Practice Location

Address: 800 S GREATHOUSE DR
City: Atoka
State: Oklahoma
ZIP Code: 74525-3431
Phone: (580) 889-2424

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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