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General NPI Number Information
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NPI Number | 1063694768
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Entity Type | Individual
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Provider Name | ERIN JACKSON DICHARRY PA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 06/23/2021
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Provider Practice Location Address
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Address Line | 2551 GREENWOOD RD STE 410
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City | SHREVEPORT
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State | LA
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Zip | 71103-3989
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Country | US
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Telephone | 318-621-2929
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Fax | 318-621-2930
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Provider Business Mailing Address
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Address Line | PO BOX 51008
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City | SHREVEPORT
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State | LA
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Zip | 71135-1008
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Country | US
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Telephone | 318-798-9400
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Fax | 318-798-6785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 200154
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License Number State | LA
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