Individual provider · Type 1 NPI
Koree Mathew Jackson
Driver · Jay, OK
NPI number
1679395313
Active
Practice location
32426 S 554 Loop
Jay, OK 74346
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Driver Primary | 172A00000X | S084009464 (OK) |
Driver: A person employed to operate a motor vehicle as a carrier of persons or property.
About NPI 1679395313
Koree Mathew Jackson's National Provider Identifier is 1679395313, issued on Oct 24, 2024. The primary taxonomy on file is Driver (172A00000X), and the practice location is in Jay, OK. The record was last updated on Oct 24, 2024.