Healthcare Provider Details

I. General information

NPI: 1700684610
Provider Name (Legal Business Name): JESSICA LAUREN NELSON APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

334 KINGFISHER RD
STERLINGTON LA
71280-3283
US

V. Phone/Fax

Practice location:
  • Phone: 318-282-0456
  • Fax:
Mailing address:
  • Phone: 318-282-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number240027
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN160090
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: