Jackson Frederick
Jackson Frederick is a Student in an Organized Health Care Education/Training Program in Tulsa, Oklahoma. Practices as a sole proprietor. Registered with an NPI since 2025.
- In the registry since
- 2025
Practice location Address checks out
1111 W 17th StTulsa, OK 74107-1886
Phone: (918) 582-1972
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Specialties & licences
| Student in an Organized Health Care Education/Training Program (primary) | Taxonomy 390200000X |
|---|
Record details
| NPI number | 1154293942 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | September 22, 2025 |
| Last updated in NPPES | October 23, 2025 |
| Certification date | October 23, 2025 |
| Mailing address | 1111 W 17th St, Tulsa, OK 74107-1886 |
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1111 W 17th St, Tulsa, OK 74107-1886 · (918) 582-1972