Individual
SANDRA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4513 PINE KNOLL DR, SHREVEPORT, LA 71107-2605
(318) 617-8095
Mailing address
4513 PINE KNOLL DR, SHREVEPORT, LA 71107-2605
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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