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General NPI Number Information
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NPI Number | 1912935578
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Entity Type | Organization
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Legal Business Name | JSK PROFESSIONAL PHYSICIAN SERVICES, LLC
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 16300 HIGHWAY 1085
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City | COVINGTON
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State | LA
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Zip | 70433-7227
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Country | US
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Telephone | 985-871-6088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 54528
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City | NEW ORLEANS
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State | LA
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Zip | 70154-4528
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Country | US
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Telephone | 985-845-9000
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Fax | 985-845-9003
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOHN KESSELS
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Credential | MD
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Telephone | 985-871-6088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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