Healthcare Provider Details

I. General information

NPI: 1871033761
Provider Name (Legal Business Name): JENNIFER FERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S HIGHLAND DR
MANY LA
71449-3719
US

IV. Provider business mailing address

305 S HIGHLAND DR
MANY LA
71449-3719
US

V. Phone/Fax

Practice location:
  • Phone: 318-256-5200
  • Fax:
Mailing address:
  • Phone: 318-256-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: