Individual
LAVASHIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2636 N 12TH ST, OCEAN SPRINGS, MS 39564-9481
(228) 281-0270
Mailing address
2636 N 12TH ST, OCEAN SPRINGS, MS 39564-9481
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Enumeration date
12/18/2025
Last updated
12/18/2025
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