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Individual

MRS. ANDREA LATRESE JACKSON-WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
5825 AIRLINE HWY, BATON ROUGE, LA 70805-2408
(225) 358-1000
Mailing address
1401 N FOSTER DR, BATON ROUGE, LA 70806-1818
(225) 987-9000

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP05569
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1311901
LA
Enumeration date
09/09/2008
Last updated
03/22/2010
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