Individual
MR. KENNETH KARL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RRT
Contact information
Practice address
2495 SHREVEPORT HWY # 71, PINEVILLE, LA 71360-4044
(318) 466-2396
Mailing address
5503 HALL ST, ALEXANDRIA, LA 71303-3918
(337) 780-8667
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
CRT200406
LA
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
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