Healthcare Provider Details

I. General information

NPI: 1740449057
Provider Name (Legal Business Name): NANCY JEPSEN BUSBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 CHATHAM AVE
CHATHAM LA
71226-8917
US

IV. Provider business mailing address

804 CHATHAM AVE
CHATHAM LA
71226-8917
US

V. Phone/Fax

Practice location:
  • Phone: 318-249-3200
  • Fax: 318-249-3204
Mailing address:
  • Phone: 318-249-3200
  • Fax: 318-249-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP05020
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: