PHYLLIS ST AMANT JACKSON

Contractor

Active Individual
NPI: 1104283340

Practice Address

13317 SOUTH CHOCTAW DRIVE
SUITE C3
Baton Rouge, LA 70815

Phone: (225) 364-6208

Specialties

Specialty Code Primary License
Contractor 171W00000X Yes -

Frequently Asked Questions

NPI 1104283340 is the National Provider Identifier for PHYLLIS ST AMANT JACKSON, a Contractor provider located in Baton Rouge, LA. This NPI was enumerated on January 19, 2016.
PHYLLIS ST AMANT JACKSON practices at 13317 SOUTH CHOCTAW DRIVE, SUITE C3, Baton Rouge, LA 70815.

Quick Facts

NPI
1104283340
Type
Individual
Enumerated
Jan 19, 2016
Last Updated
Jan 19, 2016

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