Healthcare Provider Details

I. General information

NPI: 1912935578
Provider Name (Legal Business Name): JSK PROFESSIONAL PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 HIGHWAY 1085
COVINGTON LA
70433-7227
US

IV. Provider business mailing address

PO BOX 54528
NEW ORLEANS LA
70154-4528
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-6088
  • Fax:
Mailing address:
  • Phone: 985-845-9000
  • Fax: 985-845-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN KESSELS
Title or Position: DIRECTOR
Credential: MD
Phone: 985-871-6088