MEDICARE: DR. JOHN KEVIN JACKSON M.D.

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	020998	LA
2	2084P0800X	Psychiatry Physician	020998	LA
3	2084N0400X	Neurology Physician	020998	LA

Other Identifiers

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

General Provider Information

NPI Number	:	1750347878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KEVIN JACKSON M.D.

Provider Business Mailing Address
First Line	:	6312 PERLITA DR
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-2242
Country	:	US
Telephone Number	:	504-352-0232
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA NEW ORLEANS DEPARTMENT OF MENTAL HEALTH
Second Line	:	2400 CANAL STREET
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119
Country	:	US
Telephone Number	:	504-507-3380
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/16/2021

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