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General NPI Number Information
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NPI Number | 1619475126
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Entity Type | Individual
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Provider Name | JACKELINE AILEEN MERCADO
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Gender | Female
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 9420 LINDALE AVE STE A
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City | BATON ROUGE
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State | LA
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Zip | 70815
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Country | US
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Telephone | 225-442-3540
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Fax | 224-442-3546
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Provider Business Mailing Address
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Address Line | 14435 BRIGHTVIEW CT
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City | BATON ROUGE
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State | LA
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Zip | 70819-4006
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Country | US
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Telephone | 225-810-6445
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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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