Individual
KEISHA LASHON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NRCMA
Contact information
Practice address
146 CHELSEA DR, SHREVEPORT, LA 71105-4206
(318) 996-8995
Mailing address
146 CHELSEA DR, SHREVEPORT, LA 71105-4206
(318) 996-8995
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
LA
374U00000X
Home Health Aide
Primary
—
LA
Other
Enumeration date
06/01/2022
Last updated
06/01/2022
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