Healthcare Provider Details

I. General information

NPI: 1932770880
Provider Name (Legal Business Name): JENNY MORA GRAFFATO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3616 S I 10 SERVICE RD W STE 100
METAIRIE LA
70001-1884
US

IV. Provider business mailing address

3100 WILLIAMS BLVD
KENNER LA
70065-4505
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-5257
  • Fax:
Mailing address:
  • Phone: 504-443-1744
  • Fax: 504-443-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP220980
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number220980
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: