Provider Demographics
NPI:1437501293
Name:JACKSON, KASI
Entity Type:Individual
Prefix:
First Name:KASI
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SENATE DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:LA
Mailing Address - Zip Code:70094-2443
Mailing Address - Country:US
Mailing Address - Phone:844-864-7834
Mailing Address - Fax:844-864-7834
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 7, SUITE 9A
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:844-864-8734
Practice Address - Fax:844-864-7834
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator