Provider Demographics
NPI:1508287921
Name:WILLIAMS-JACKSON, ROBERTNIQUE WAYNETTE
Entity type:Individual
Prefix:
First Name:ROBERTNIQUE
Middle Name:WAYNETTE
Last Name:WILLIAMS-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROBERTNIQUE
Other - Middle Name:WAYNETTE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 CHINABERRY DR STE 900
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2455
Mailing Address - Country:US
Mailing Address - Phone:318-480-1227
Mailing Address - Fax:
Practice Address - Street 1:1000 CHINABERRY DR STE 900
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2455
Practice Address - Country:US
Practice Address - Phone:318-480-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator