Healthcare Provider Details

I. General information

NPI: 1982185799
Provider Name (Legal Business Name): JENNIFER LEE COOLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BON AMI ST
DERIDDER LA
70634-4925
US

IV. Provider business mailing address

501 BON AMI ST
DERIDDER LA
70634-4925
US

V. Phone/Fax

Practice location:
  • Phone: 337-202-1093
  • Fax: 337-221-1073
Mailing address:
  • Phone: 337-202-1093
  • Fax: 337-221-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: