Provider Demographics
NPI:1649747684
Name:WASHINGTON, JOCELYN MORGAN (OWNER, OPERATOR)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MORGAN
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:OWNER, OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 RUSSELL EARL RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-8018
Mailing Address - Country:US
Mailing Address - Phone:318-512-7479
Mailing Address - Fax:
Practice Address - Street 1:193 RUSSELL EARL RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-8018
Practice Address - Country:US
Practice Address - Phone:318-512-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver