Healthcare Provider Details

I. General information

NPI: 1780852962
Provider Name (Legal Business Name): JENNIFER LEVINSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S. FARMERVILLE STREET
RUSTON LA
71270
US

IV. Provider business mailing address

PO BOX 445
RUSTON LA
71273-0445
US

V. Phone/Fax

Practice location:
  • Phone: 318-436-2600
  • Fax: 318-436-2601
Mailing address:
  • Phone: 318-436-2600
  • Fax: 318-436-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP05230
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN099522
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: