Healthcare Provider Details

I. General information

NPI: 1841108933
Provider Name (Legal Business Name): TYKERIA LASHAE JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERIE JACKSON CNM

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 PRYTANIA ST STE 35
NEW ORLEANS LA
70115-3678
US

IV. Provider business mailing address

1142 MICHAEL ST
NEW ORLEANS LA
70114-1825
US

V. Phone/Fax

Practice location:
  • Phone: 225-241-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number217795
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: