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General NPI Number Information
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NPI Number | 1942672282
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Entity Type | Individual
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Provider Name | PAIGE HEWLETT JACKSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2015
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1605 BENTON RD
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3578
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Country | US
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Telephone | 318-716-3814
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Fax |
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Provider Business Mailing Address
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Address Line | 382 ALDEN BRIDGE LOOP
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City | BENTON
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State | LA
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Zip | 71006-8618
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Country | US
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Telephone | 318-218-6712
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12713
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 301790
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License Number State | LA
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