Individual
JAZZ JANNIE BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHP
Contact information
Practice address
2715 MACKEY PL, SUITE 139, SHREVEPORT, LA 71118-2544
(318) 220-8423
Mailing address
1002 N MAIN ST, FARMERVILLE, LA 71241-8382
(318) 450-8361
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003279654
—
LA
Enumeration date
08/20/2016
Last updated
11/26/2018
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