Latonya C Jackson
Individual provider Active NPI Contractor · Simsboro, LA
NPI 1598063083 · NPPES record last updated Mar 8, 2011
Key facts
- NPI
- 1598063083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 121 Sims St
Simsboro, LA 71275-3208 - Phone
- (318) 247-8439
- Fax
- (318) 242-4698
- NPI assigned
- Mar 7, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
121 Sims St
Simsboro, LA 71275-3208
Mailing address
121 Sims St
Simsboro, LA 71275-3208
Phone (318) 247-8439
Other providers in Simsboro, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.