NPI 1104283340

Phyllis St Amant Jackson

Practitioner Contractor Baton Rouge, LA

Practice location

Address: 13317 South Choctaw Drive Suite C3, Baton Rouge, LA 70815
Phone: (225) 364-6208
Mailing address: 7852 Phebus Drive, Baton Rouge, LA 70812-3144

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1104283340
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Jan 2016
Record last updated: 19 Jan 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.