Jackson, Louella M

Jackson, Louella M is an individual health care provider with primary practice located at 2000 Opelousas St , Lake Charles LA 70601. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Louella M can be contacted via phone (337) 439-9983.

Contact Information

Primary practice address
2000 Opelousas St Lake Charles LA 70601
Phone: (337) 439-9983
Fax: (337) 439-8898
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP03007 Louisiana

Profile Details

NPI number 1871630004
LBN Legal business name Jackson, Louella M
Credentials FNPC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2007
Last updated Aug 1st, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871630004 NPPES
Louisiana MEDICAID 1691810

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