Individual
KODI LONG JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-3631
(601) 200-0159
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(601) 200-4644
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/16/2022
Last updated
11/03/2025
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