NPI 1679395313

Koree Mathew Jackson

Practitioner Driver Jay, OK

Practice location

Address: 32426 S 554 Loop, Jay, OK 74346
Phone: (417) 680-4587

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence S084009464 (OK)

Other Driver providers in Oklahoma →

Registry record

NPI: 1679395313
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Oct 2024
Record last updated: 24 Oct 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.