Healthcare Provider Details

I. General information

NPI: 1508599226
Provider Name (Legal Business Name): KEVIN F JURA DRPH(C), NRP, FRSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 GRAVIER ST APT 303
NEW ORLEANS LA
70112-2043
US

IV. Provider business mailing address

1315 GRAVIER ST APT 303
NEW ORLEANS LA
70112-2043
US

V. Phone/Fax

Practice location:
  • Phone: 850-393-4550
  • Fax:
Mailing address:
  • Phone: 850-393-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0209701
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP0902861
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberLA23-3166
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: