Provider Demographics
NPI:1649579376
Name:JACKSON, VENETRA (RN)
Entity Type:Individual
Prefix:
First Name:VENETRA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5754
Mailing Address - Country:US
Mailing Address - Phone:985-543-4800
Mailing Address - Fax:985-543-4817
Practice Address - Street 1:130 ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5754
Practice Address - Country:US
Practice Address - Phone:985-543-4800
Practice Address - Fax:985-543-4817
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097146163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult