Individual
MISS TREVIA M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 CANAL ST # D&T2720, NEW ORLEANS, LA 70112-3018
(504) 702-2287
Mailing address
1501 RED RIVER ST FL 2, AUSTIN, TX 78712-1845
(512) 495-5555
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
331554
LA
207P00000X
Emergency Medicine Physician
U9978
TX
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
U9978
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2020
Last updated
06/12/2024
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