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Jordan Tyler Jackson, MEDICALSTUDENT
Student in an Organized Health Care Education/Training Program in Edmond, Oklahoma
NPI 1891315222

Jordan Tyler Jackson is a Student in an Organized Health Care Education/Training Program based in Edmond, OK. Jordan Tyler Jackson practices in Edmond, OK and has the professional credentials of MEDICALSTUDENT. The NPI Number for Jordan Tyler Jackson is 1891315222 and holds a License No. (Oklahoma).

The current practice location address for Jordan Tyler Jackson is 19512 Crest Ridge Dr, Edmond, OK and can be reached out via phone at 918-367-8128. You can also correspond with Jordan Tyler Jackson through the mailing address at 19512 CREST RIDGE DR, EDMOND, OK - 73012-3504 (mailing address contact number: 918-367-8128).

Location: 19512 Crest Ridge Dr, Edmond, OK, 73012-3504
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1891315222
Provider Name
Jordan Tyler Jackson
Credential
MEDICALSTUDENT
Provider Entity Type
Individual
Gender
Male
Address
19512 Crest Ridge Dr, Edmond, OK, 73012-3504
Phone Number
918-367-8128
Fax Number
Provider Enumeration Date
04/27/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
19512 Crest Ridge Dr
City
Edmond
State
Oklahoma
Zip
73012-3504
Phone Number
918-367-8128
Fax Number
person
Provider Business Mailing Address Details
Address
19512 Crest Ridge Dr
City
Edmond
State
Oklahoma
Zip
73012-3504
Phone Number
918-367-8128
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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