Healthcare Provider Details

I. General information

NPI: 1659918753
Provider Name (Legal Business Name): JENNA JO BEHLAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2019
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 HIGHWAY 22
MANDEVILLE LA
70471
US

IV. Provider business mailing address

4910 HIGHWAY 22
MANDEVILLE LA
70471-2813
US

V. Phone/Fax

Practice location:
  • Phone: 985-778-0788
  • Fax:
Mailing address:
  • Phone: 985-778-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN.1637012
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0995256-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213925
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: