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General NPI Number Information
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NPI Number | 1134674047
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Entity Type | Individual
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Provider Name | JAZZ JANNIE BRYANT MHP
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Gender | Female
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 11/26/2018
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Provider Practice Location Address
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Address Line | 2715 MACKEY PL SUITE 139
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City | SHREVEPORT
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State | LA
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Zip | 71118-2544
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Country | US
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Telephone | 318-220-8423
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 N MAIN ST
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City | FARMERVILLE
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State | LA
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Zip | 71241-8382
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Country | US
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Telephone | 318-450-8361
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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