Basic Information
| Provider Information | |||||||||
| NPI: | 1194340695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVARE | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5541 HIGHWAY 1 | ||||||||
| Address2: | PO BOX 249 | ||||||||
| City: | MARKSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713512650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182407240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5541 HIGHWAY 1 | ||||||||
| Address2: | |||||||||
| City: | MARKSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713512650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182407240 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2020 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F06200333 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.