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Individual

TIMOTHY JAMES JACKSON

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
155 HOSPITAL DR, LAFAYETTE, LA 70503-2852
(337) 269-9777
(337) 269-0244
Mailing address
PO BOX 52507, LAFAYETTE, LA 70505-2507
(337) 269-9777
(337) 269-0244

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN 073450
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1949388
LA
Enumeration date
10/06/2005
Last updated
07/08/2007
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