Basic Information
| Provider Information | |||||||||
| NPI: | 1013575695 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J.L. NURSE PRACTITIONER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5909 PATSY DELL DR | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713037027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182296164 | ||||||||
| FaxNumber: | 3184439116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1635 MARVEL ST | ||||||||
| Address2: | |||||||||
| City: | COUSHATTA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710199022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189322081 | ||||||||
| FaxNumber: | 3189322215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2019 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | PERRY | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PMHNP | ||||||||
| AuthorizedOfficialTelephone: | 3182296164 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.