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NPI Code Detail

MEDICARE: AMANDA ANN BROWN JACKSON MD

MEDICARE: AMANDA ANN BROWN JACKSON MD
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
1208000000XPediatrics PhysicianMD200328LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710964564
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA ANN BROWN JACKSON MD
Provider Business Mailing Address
First Line : 1514 JEFFERSON HWY
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70121
Country : US
Telephone Number : 504-842-4000
Fax Number :
Provider Business Practice Location Address
First Line : 200 HENRY CLAY AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70118-5798
Country : US
Telephone Number : 504-896-9827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 08/14/2019

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Directions to “ AMANDA ANN BROWN JACKSON MD” Practice Location

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