Individual
PAIGE HEWLETT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1605 BENTON RD, BOSSIER CITY, LA 71111-3578
(318) 716-3814
Mailing address
382 ALDEN BRIDGE LOOP, BENTON, LA 71006-8618
(318) 218-6712
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
301790
LA
363A00000X
Physician Assistant
PA12713
TX
Other
Enumeration date
10/27/2015
Last updated
10/01/2024
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