Healthcare Provider Details

I. General information

NPI: 1659840536
Provider Name (Legal Business Name): JESSICA NICOLE WHITE HAIR LOSS SPECIALIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8676 GOODWOOD BLVD STE 402
BATON ROUGE LA
70806-7914
US

IV. Provider business mailing address

3051 MARGEBROOK DR
BATON ROUGE LA
70816-2666
US

V. Phone/Fax

Practice location:
  • Phone: 225-800-7110
  • Fax:
Mailing address:
  • Phone: 225-276-3492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: