Individual
BARTHOLOMEW ERIC JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
7861 CAMELLIA BUD CT, SLIDELL, LA 70461-6648
(315) 281-6945
Mailing address
7861 CAMELLIA BUD CT, SLIDELL, LA 70461-6648
(315) 281-6945
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
220378
LA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
220378
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220378
PSYCHIATRY
LA
Enumeration date
01/12/2023
Last updated
03/07/2023
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