Healthcare Provider Details

I. General information

NPI: 1023585635
Provider Name (Legal Business Name): JENNA SEETS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 BIENVILLE RD
RINGGOLD LA
71068-2588
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-894-2341
  • Fax:
Mailing address:
  • Phone: 318-209-4510
  • Fax: 318-209-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200272
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: