Individual
FANNIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5841 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6036
(225) 256-3556
Mailing address
24710 HIGHWAY 1, PLAQUEMINE, LA 70764-4163
(225) 238-7661
(225) 238-7667
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
253Z00000X
—
Other
Enumeration date
08/18/2016
Last updated
06/16/2021
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