1942787684 NPI number — APRIL LATASHA JACKSON FNP

Table of content: APRIL LATASHA JACKSON FNP (NPI 1942787684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942787684 NPI number — APRIL LATASHA JACKSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACKSON
Provider First Name:
APRIL
Provider Middle Name:
LATASHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942787684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 DULLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70506-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-991-9276
Provider Business Mailing Address Fax Number:
337-943-0846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 WESTFORK DR STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70827-0004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-991-9276
Provider Business Practice Location Address Fax Number:
337-943-0846
Provider Enumeration Date:
07/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP10004 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2478907 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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