Individual ProviderKristen Imani JacksonCase Manager/Care CoordinatorOther Service ProvidersPractice Address1995 Gentilly Blvd Ste C-400, New Orleans, LA 70119-1700(504) 944-0453PECOS EnrollmentBased on the most recent information from CMS, provider Kristen Imani Jackson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1982211355Provider TypeIndividualFull NameJackson, Kristen ImaniCredentialCSWGenderFemaleSole ProprietorNoEnumeration Date9/29/2020Last Updated9/29/2020Contact InformationPractice LocationPractice Address1995 Gentilly Blvd Ste C-400, New Orleans, LA 70119-1700Phone(504) 944-0453Fax(504) 944-0095Mailing LocationMailing Address1995 Gentilly Blvd Ste C-400, New Orleans, LA 70119-1700Phone(504) 944-0453Fax(504) 944-0095Provider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer