Provider Demographics
NPI:1659044501
Name:JACKSON, JENAY CHRISTINA
Entity Type:Individual
Prefix:
First Name:JENAY
Middle Name:CHRISTINA
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 1:62273 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-4503
Mailing Address - Country:US
Mailing Address - Phone:985-685-8998
Mailing Address - Fax:
Practice Address - Street 1:106 SMART PL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2040
Practice Address - Country:US
Practice Address - Phone:504-241-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator