Individual
AMBER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1644 CARTER ST # B, VIDALIA, LA 71373-3143
(318) 414-3065
(318) 414-3067
Mailing address
1644 CARTER ST # B, VIDALIA, LA 71373-3143
(318) 414-3065
(318) 414-3067
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
10/22/2015
Last updated
01/07/2019
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