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NPI 1104283340

IndividualActive

Phyllis St Amant Jackson

NPI 1104283340 · Contractor · Baton Rouge, LA

Provider details

NPI number: 1104283340
Entity type: Individual
Primary specialty: ContractorOther Service Providers
Sex: Female
Sole proprietor: Yes

Practice location

13317 South Choctaw Drive

Suite C3

Baton Rouge, LA 70815

Phone: (225) 364-6208

More LA providers

Mailing address

7852 Phebus Drive

Baton Rouge, LA 70812-3144

Registry dates

Enumerated: 2016-01-19
Last updated: 2016-01-19

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Phyllis St Amant Jackson — NPI 1104283340, Baton Rouge, LA | NPI Central