Organization
JACKSON STREET PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAI A WICKER-BROWN MD (OWNER)
(313) 300-3637
Entity
Organization
Contact information
Practice address
5716 JACKSON ST, ALEXANDRIA, LA 71303-2042
(318) 767-6503
(318) 703-8257
Mailing address
6326 WINDY OAKS, ALEXANDRIA, LA 71301-2966
(313) 300-3637
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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