Healthcare Provider Details

I. General information

NPI: 1831910124
Provider Name (Legal Business Name): JESSICA KLUMPP LAZZARA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1581 CAROL SUE AVE STE D
GRETNA LA
70056-5100
US

IV. Provider business mailing address

1581 CAROL SUE AVE STE D
GRETNA LA
70056-5100
US

V. Phone/Fax

Practice location:
  • Phone: 844-677-2968
  • Fax: 504-350-3511
Mailing address:
  • Phone: 844-677-2968
  • Fax: 504-350-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number237704
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: