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NPI Code Detail

MEDICARE: ALLISON R. JACKSON PA-C

MEDICARE: ALLISON R. JACKSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantA10363LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063489003
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON R. JACKSON PA-C
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 257-655-7272
Fax Number : 225-765-9196
Provider Business Practice Location Address
First Line : 18901 GREENWELL SPRINGS RD
Second Line :
City : GREENWELL SPRINGS
State : LA
Zip : 70739-4827
Country : US
Telephone Number : 225-924-9985
Fax Number : 225-924-0884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 03/26/2021

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