Healthcare Provider Details

I. General information

NPI: 1649194572
Provider Name (Legal Business Name): JAMMIELLE WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 N I-10 SERVICE RD
METAIRIE LA
70007
US

IV. Provider business mailing address

504 PLYMOUTH DR
LA PLACE LA
70068-2365
US

V. Phone/Fax

Practice location:
  • Phone: 985-703-9836
  • Fax:
Mailing address:
  • Phone: 985-703-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: