Individual
MARIAH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5646 READ BLVD, STE280, NEW ORLEANS, LA 70127-3106
(504) 246-1452
Mailing address
420 S PIERCE ST, NEW ORLEANS, LA 70119-6802
(504) 473-6459
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP07812
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09034856
—
MS
05
—
2370472
—
LA
Enumeration date
06/06/2014
Last updated
03/29/2017
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