Healthcare Provider Details

I. General information

NPI: 1598280752
Provider Name (Legal Business Name): JENNIFER ANN CALVERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

1120 BROOKHAVEN AVE
RUSTON LA
71270-8505
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2456
  • Fax:
Mailing address:
  • Phone: 318-255-1739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09524
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: