Most Relevant Information
Provider Data
| NPI Number: | 1003300955 |
| Provider Name: | CARNETTE JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/14/2018 |
| Last Updated: | 06/14/2018 |
Provider Practice Location
12561 WARDLINE RD
HAMMOND
LA
704016212
Practice Location Phone/Fax
| Phone: | 9855515155 |
| Fax: |
Provider Mailing Location
PO BOX 2703
HAMMOND
LA
704042703
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |