Healthcare Provider Details

I. General information

NPI: 1003955956
Provider Name (Legal Business Name): JENNIFER JAMES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 COLISEUM BLVD
ALEXANDRIA LA
71303-3714
US

IV. Provider business mailing address

5920 COLISEUM BLVD
ALEXANDRIA LA
71303-3714
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9339
  • Fax: 318-443-9116
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN110654
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2010014251
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: