Healthcare Provider Details

I. General information

NPI: 1285981068
Provider Name (Legal Business Name): JENNIFER STEVENS JUNEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2012
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 SHERWOOD DR
RUSTON LA
71270-2157
US

IV. Provider business mailing address

902 SHERWOOD DR
RUSTON LA
71270-2157
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-3774
  • Fax: 318-251-0442
Mailing address:
  • Phone: 318-251-3774
  • Fax: 318-251-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06980
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: