Individual
MR. KENNETH LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1216 OKLAHOMA ST, LAKE CHARLES, LA 70607-3624
(337) 414-0914
Mailing address
1216 OKLAHOMA ST, LAKE CHARLES, LA 70607-3624
(337) 414-0914
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
08/01/2022
Last updated
08/01/2022
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