Healthcare Provider Details

I. General information

NPI: 1316258262
Provider Name (Legal Business Name): SIDNEY M JACKLER MPA, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OCHSNER BLVD
COVINGTON LA
70433-8107
US

IV. Provider business mailing address

1000 OCHSNER BLVD DEPT OF HEADACHE NEUROLOGY
COVINGTON LA
70433-8107
US

V. Phone/Fax

Practice location:
  • Phone: 985-338-5333
  • Fax: 985-875-2806
Mailing address:
  • Phone: 985-338-5333
  • Fax: 985-875-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200780
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: