Individual
MRS. PATRICE QUINETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7274 MODESTO AVE, BATON ROUGE, LA 70811-4427
(225) 288-7917
Mailing address
7274 MODESTO AVE, BATON ROUGE, LA 70811-4427
(225) 288-7917
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
005562615
LA
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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