Individual
DR. CRYSTAL B JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
700 SOUTHLAKE CIR, YOUNGSVILLE, LA 70592-5671
(703) 350-1912
Mailing address
700 SOUTHLAKE CIR, YOUNGSVILLE, LA 70592-5671
(703) 350-1912
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00856598
RAILROAD MEDICARE
DC
Enumeration date
07/22/2008
Last updated
10/01/2012
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