Healthcare Provider Details

I. General information

NPI: 1689256612
Provider Name (Legal Business Name): SONDRA JENESS RASBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY RASBURY APRN FNP-C

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-7407
US

IV. Provider business mailing address

421 HAVEN LOOP
CHATHAM LA
71226-9593
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4541
  • Fax:
Mailing address:
  • Phone: 318-655-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number219391
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219391
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: