Provider Demographics
NPI:1164794483
Name:JACKSON, YASMIN MICHELLE (BSN, MED)
Entity Type:Individual
Prefix:MRS
First Name:YASMIN
Middle Name:MICHELLE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:BSN, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S ASP ST
Mailing Address - Street 2:
Mailing Address - City:COYLE
Mailing Address - State:OK
Mailing Address - Zip Code:73027-9427
Mailing Address - Country:US
Mailing Address - Phone:405-371-3040
Mailing Address - Fax:
Practice Address - Street 1:516 S ASP ST
Practice Address - Street 2:
Practice Address - City:COYLE
Practice Address - State:OK
Practice Address - Zip Code:73027-9427
Practice Address - Country:US
Practice Address - Phone:405-371-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health