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General NPI Number Information
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NPI Number | 1396628681
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Entity Type | Organization
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Legal Business Name | PEACE OUTPOST
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Dates
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Enumeration Date | 07/26/2025
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 1423 E WILLOW ST APT 5
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City | LAFAYETTE
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State | LA
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Zip | 70501-3834
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Country | US
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Telephone | 337-254-0675
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Fax |
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Provider Business Mailing Address
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Address Line | 628 N 4TH ST
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City | BATON ROUGE
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State | LA
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Zip | 70802-5342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL OFFICER
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Name | DR. KYLE JACKSON
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Credential |
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Telephone | 720-335-5339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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