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NPI Code Detail

MEDICARE: CAROLYN JACKSON

MEDICARE: CAROLYN 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
1253Z00000XIn Home Supportive Care Agency00922173LA

General Provider Information

NPI Number : 1740723972
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN JACKSON
Provider Business Mailing Address
First Line : 301 MAIN ST STE 2200
Second Line :
City : BATON ROUGE
State : LA
Zip : 70801-0014
Country : US
Telephone Number : 225-224-6780
Fax Number : 225-226-6701
Provider Business Practice Location Address
First Line : 301 MAIN ST STE 2200
Second Line :
City : BATON ROUGE
State : LA
Zip : 70801-0014
Country : US
Telephone Number : 225-224-6780
Fax Number : 225-226-6701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2016
Last Update Date : 11/20/2016

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Directions to “ CAROLYN JACKSON ” Practice Location

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