Healthcare Provider Details

I. General information

NPI: 1912490764
Provider Name (Legal Business Name): JESSICA DAWN IVEY COKER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DAWN IVEY AUD

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 BIENVILLE DR
MONROE LA
71201
US

IV. Provider business mailing address

1691 BIENVILLE DR
MONROE LA
71201-3756
US

V. Phone/Fax

Practice location:
  • Phone: 318-990-5390
  • Fax: 318-990-5749
Mailing address:
  • Phone: 318-990-5390
  • Fax: 318-990-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7481
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: