Healthcare Provider Details

I. General information

NPI: 1275660631
Provider Name (Legal Business Name): JESSICA B KRAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S ROBERTSON ST SUITE 1340
NEW ORLEANS LA
70112-2807
US

IV. Provider business mailing address

131 S ROBERTSON ST SUITE 1340
NEW ORLEANS LA
70112-2807
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4564
  • Fax: 504-988-9191
Mailing address:
  • Phone: 504-988-4564
  • Fax: 504-988-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number207193
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: