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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, April 19, 2024 1:07 PM CDT
Next Update: Friday, April 19, 2024 4:30 PM CDT

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JACKSON, JESSICA ELISE
Practice Address: 2212 N BROADWAY AVE
MOORE OK 73160

Address last updated on 3/23/2024
Phone #: (405) 285-7222
Fax #:
County: CLEVELAND
License: 2725
Dated: 1/26/2017
Expires: 3/31/2025
Temp. Ltr. Issued: 12/29/2016
Temp. Ltr. Expires: 3/2/2017
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Locations: Hours: Languages:
2212 N BROADWAY AVE
MOORE OK 73160

Phone #: (405) 285-7222
Fax #:

Hospital Privileges:

None listed

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
DUSTIN RILEY BAKER MD 23973
JOSEPH CLIFTON BROOME MD 23006
JAMES LE DO 5402
CYRUS DEAN MOTAZEDI DO 3977

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