Individual provider · NPI-1

Reginald D Jackson

Technician, Attendant Care Provider · Lafayette, LA

NPI number1558041491
StatusActive
Last updated in NPPESJul 24, 2023

Details

NPI
1558041491
Entity type
Individual (NPI-1)
Name
Reginald D Jackson
Sex
Male
Sole proprietor
No
Enumeration date
Jul 24, 2023
Certification date
Jul 24, 2023
Last updated
Jul 24, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3747A0650X Technician, Attendant Care Provider––Yes

Practice location

515 S College Rd
Lafayette, LA 70503-3352

Phone 337-269-1165

Mailing address

515 S College Rd
Lafayette, LA 70503-3352

Phone 337-269-1165

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