Healthcare Provider Details

I. General information

NPI: 1780297234
Provider Name (Legal Business Name): JENNIFER S OSBORNE ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST STE 5B
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

2600 GREENWOOD RD
SHREVEPORT LA
71103-3908
US

V. Phone/Fax

Practice location:
  • Phone: 318-767-0605
  • Fax: 318-767-0086
Mailing address:
  • Phone: 318-212-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number908314
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number215455
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number215455
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: