Healthcare Provider Details

I. General information

NPI: 1952217127
Provider Name (Legal Business Name): FRANKIE J JACKSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY STE H
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

429 W AIRLINE HWY STE H
LA PLACE LA
70068-3817
US

V. Phone/Fax

Practice location:
  • Phone: 985-618-3403
  • Fax: 985-618-3404
Mailing address:
  • Phone: 985-618-3403
  • Fax: 985-618-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: