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NPI Code Detail

MEDICARE: GELINIA JACKSON APRN

MEDICARE: GELINIA JACKSON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP134443TX
2363LF0000XFamily Nurse PractitionerAP09441LA

General Provider Information

NPI Number : 1518479948
Entity Type Code : Individual
Provider Name (Legal Business Name) : GELINIA JACKSON APRN
Provider Business Mailing Address
First Line : 1541 KINGS HWY
Second Line :
City : SHREVEPORT
State : LA
Zip : 71103-4228
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2890 DOUGLAS DR
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-5806
Country : US
Telephone Number : 318-742-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2017
Last Update Date : 02/12/2025

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