Individual
JACKQUAIL CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2800 YOUREE DR STE 204, SHREVEPORT, LA 71104-3668
(318) 585-0213
Mailing address
7300 W CANAL BLVD, SHREVEPORT, LA 71108-4914
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
08/10/2021
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