Individual
REGINALD D JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 S COLLEGE RD, LAFAYETTE, LA 70503-3352
(337) 269-1165
Mailing address
515 S COLLEGE RD, LAFAYETTE, LA 70503-3352
(337) 269-1165
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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