Basic Information
Provider Information
NPI: 1114387586
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEPINE
FirstName: JENNIFER
MiddleName: PERRY
NamePrefix:  
NameSuffix:  
Credential: N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5959 S SHERWOOD FOREST BLVD
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708166038
CountryCode: US
TelephoneNumber: 2255260006
FaxNumber: 2257659291
Practice Location
Address1: 8200 CONSTANTIN BLVD FL 1
Address2:  
City: BATON ROUGE
State: LA
PostalCode: 708093481
CountryCode: US
TelephoneNumber: 2257655500
FaxNumber: 2253740501
Other Information
ProviderEnumerationDate: 02/29/2016
LastUpdateDate: 01/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP08668LAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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