Healthcare Provider Details

I. General information

NPI: 1609120211
Provider Name (Legal Business Name): JENNIFER ASHLEY WAINWRIGHT APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 3RD AVE STE 350
LAKE CHARLES LA
70601-0404
US

IV. Provider business mailing address

PO BOX 122309 DEPT 2309
DALLAS TX
75312-2309
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-2750
  • Fax: 337-494-2760
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06939
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP06939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: