Timber Laine Jackson, FNP-C
Nurse Practitioner, Family in Tuttle, OK. Individual provider (NPI-1).
NPI number1164021150
StatusActive
Last updated in NPPESOct 20, 2020
Details
- NPI
- 1164021150
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Timber Laine Jackson
- Credential
- FNP-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 20, 2020
- Certification date
- Oct 20, 2020
- Last updated
- Oct 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 98752 | OK | Yes |
Practice location
1391 County Road 1215Tuttle, OK 73089-3047
Phone 405-412-5862
Mailing address
1391 County Road 1215Tuttle, OK 73089-3047
Phone 405-412-5862
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