Individual
JACQUELYN KATE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 S CLEARVIEW PKWY, JEFFERSON, LA 70121-1015
(770) 314-5438
Mailing address
516 MARE CT, COVINGTON, LA 70435-0590
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
320563
LA
2255A2300X
Athletic Trainer
AT-982
MS
2255A2300X
Athletic Trainer
AT003108
GA
Other
Enumeration date
06/05/2020
Last updated
06/05/2020
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