Individual
MS. CHARLETTA WILLIAMS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA/CNA
Contact information
Practice address
9151 INTERLINE AVE STE 5-B, BATON ROUGE, LA 70809-1970
(225) 444-5096
(833) 926-1772
Mailing address
9151 INTERLINE AVE STE 5-B, BATON ROUGE, LA 70809-1970
(225) 444-5096
(833) 926-1772
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
313120
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
LA
Enumeration date
09/23/2021
Last updated
09/23/2021
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