Individual
SHANTASIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 NORTH BLVD STE 200, BATON ROUGE, LA 70806-3743
(225) 381-6620
Mailing address
3401 NORTH BLVD STE 200, BATON ROUGE, LA 70806-3743
(225) 381-6620
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/25/2024
Last updated
08/21/2024
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