Individual
KENANNA ANTOWAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
433 FLOURNOY LUCAS RD LOT 18, SHREVEPORT, LA 71106-8113
(318) 683-8356
Mailing address
433 FLOURNOY LUCAS RD LOT 18, SHREVEPORT, LA 71106-8113
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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