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NPI Code Detail

MEDICARE: JEREMY BRANDT JENNY PHYSICIAN ASSISTANT

MEDICARE: JEREMY BRANDT JENNY PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant200142LA

General Provider Information

NPI Number : 1699089417
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY BRANDT JENNY PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 5475 ESSEN LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3737
Country : US
Telephone Number : 225-767-8493
Fax Number :
Provider Business Practice Location Address
First Line : 5475 ESSEN LN
Second Line :
City : BATON ROUGE
State : LA
Zip : 70809-3737
Country : US
Telephone Number : 225-767-8493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2010
Last Update Date : 08/04/2010

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