Byron Reynard Jackson Sr.
Individual provider Active NPI Driver · Amite, LA
NPI 1982304887 · NPPES record last updated Mar 8, 2023
Key facts
- NPI
- 1982304887
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 005750531 (LA)
- Practice address
- 661 Sawmill Rd
Amite, LA 70422-6630 - Phone
- (504) 319-8430
- NPI assigned
- Mar 8, 2023
- Sex
- Male
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005750531 | LA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 005750531 | LA | Yes |
Addresses
Primary practice location
661 Sawmill Rd
Amite, LA 70422-6630
Mailing address
661 Sawmill Rd
Amite, LA 70422-6630
Phone (504) 319-8430
Other providers in Amite, LA
- Hospital Service District 2 of the Parish of Tangipahoa State of la.
- Hospital Service District 2 of the Parish of Tangipahoa State of la.
- Hospital Service District 2 of the Parish of Tangipahoa State of la.
- Zandi Watson Hudspeth
- Inspire Intellect, LLC
- Chantalyn Jackson
- Jacob Roger Smith DDS LLC
- Mary Jenkins
- Chandra Johnson
- Lorenda Johnson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2023. 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.