Basic Information
| Provider Information | |||||||||
| NPI: | 1528434081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTRELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DNP, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44354 HIGHWAY 445 | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704551999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855422466 | ||||||||
| FaxNumber: | 9855422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 44354 HIGHWAY 445 | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ROBERT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704551999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855422466 | ||||||||
| FaxNumber: | 9855422755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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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 | 363LF0000X | AP08492 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.