Individual
JADETRICK I JAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8101 KINGSTON RD STE 101B, SHREVEPORT, LA 71108
(318) 606-5335
(318) 606-5671
Mailing address
9060 AVALON DR, SHREVEPORT, LA 71118-2532
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/26/2018
Last updated
05/21/2018
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