Individual
JACKSON LABOUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5899 BREMO RD STE 100, RICHMOND, VA 23226-1935
(804) 288-8512
(804) 288-4552
Mailing address
1115 BOULDERS PKWY STE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110007683
VA
Other
Enumeration date
10/06/2020
Last updated
03/17/2021
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