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NPI Code Detail

MEDICARE: TRAVION JACKSON

MEDICARE: TRAVION 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
1171M00000XCase Manager/Care Coordinator5423LA
2101YA0400XAddiction (Substance Use Disorder) Counselor012121095LA

General Provider Information

NPI Number : 1881339273
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVION JACKSON
Provider Business Mailing Address
First Line : 1700 LAKE ST
Second Line :
City : LAKE PROVIDENCE
State : LA
Zip : 71254-5208
Country : US
Telephone Number : 318-341-8147
Fax Number :
Provider Business Practice Location Address
First Line : 645 HIGHWAY 80 E
Second Line :
City : MONROE
State : LA
Zip : 71203-8527
Country : US
Telephone Number : 318-343-8744
Fax Number : 318-345-7123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2022
Last Update Date : 04/20/2026

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Directions to “ TRAVION JACKSON ” Practice Location

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