Individual
PHYLLIS ST AMANT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13317 SOUTH CHOCTAW DRIVE, SUITE C3, BATON ROUGE, LA 70815
(225) 364-6208
Mailing address
7852 PHEBUS DRIVE, BATON ROUGE, LA 70812-3144
(225) 364-6208
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/19/2016
Last updated
01/19/2016
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