MEDICARE: JAYLYNN FAITH JACKSON

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
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1619827177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYLYNN FAITH JACKSON

Provider Business Mailing Address
First Line	:	2320 DRUSILLA LN STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1495
Country	:	US
Telephone Number	:	225-249-5078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 DRUSILLA LN STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1495
Country	:	US
Telephone Number	:	225-249-5078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “ JAYLYNN FAITH JACKSON ” Practice Location

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