Individual
LATAVIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
264 WICHITA ST, SHREVEPORT, LA 71101-4932
(318) 254-3193
Mailing address
264 WICHITA ST, SHREVEPORT, LA 71101-4932
(318) 254-3193
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
2203782259
LA
Other
Enumeration date
03/25/2022
Last updated
03/25/2022
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