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: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S. 10TH ST.
LEESVILLE LA
71446
US

IV. Provider business mailing address

PO BOX 130
NEW LIANO LA
71461
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2207
  • Fax: 337-239-2583
Mailing address:
  • Phone:
  • Fax:

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: