Jackson, Stacey Jo

Jackson, Stacey Jo is an sole proprietor health care provider with primary practice located at 17 S Central Ave , Idabel OK 74745-4625. She recently has only one registered license in Other Service Providers / Specialist, which is considered as her primary health care specialty. Jackson, Stacey Jo can be contacted via phone (580) 306-0303.

Contact Information

Primary practice address
17 S Central Ave Idabel OK 74745-4625
Phone: (580) 306-0303
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X

Profile Details

NPI number 1477849826
LBN Legal business name Jackson, Stacey Jo
Credentials BHRS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 23rd, 2011
Last updated Jun 23rd, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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