Most Relevant Information
Provider Data
| NPI Number: | 1003567009 |
| Provider Name: | YOLANDA JACKSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/12/2022 |
| Last Updated: | 01/12/2022 |
Provider Practice Location
1440 HAWN AVE
SHREVEPORT
LA
711076532
Practice Location Phone/Fax
| Phone: | 3182265990 |
| Fax: |
Provider Mailing Location
1440 HAWN AVE
SHREVEPORT
LA
711076532
Provider Mailing Phone/Fax
| Phone: | 3182265990 |
| Fax: |