Basic Information
| Provider Information | |||||||||
| NPI: | 1336244961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCVAY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69004 | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713069004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2495 SHREVEPORT HWY | ||||||||
| Address2: | HWY 71 NORTH | ||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713604044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184730010 | ||||||||
| FaxNumber: | 3184835036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA200018 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.