Phyllis St Amant Jackson

NPI #1104283340 in Baton Rouge, Louisiana

Provider Information

NPI Number: 1104283340
Entity Type: Individual
Name: Phyllis St Amant Jackson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Contractor
Enumeration Date: Jan 19, 2016
Last Updated: Jan 19, 2016

Practice Location

Address: 13317 SOUTH CHOCTAW DRIVE
Address 2: SUITE C3
City: Baton Rouge
State: Louisiana
ZIP Code: 70815
Phone: (225) 364-6208

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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