Healthcare Provider Details

I. General information

NPI: 1144627316
Provider Name (Legal Business Name): JENNIFER S STAUTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L. STANTON NP

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GAUSE BLVD
SLIDELL LA
70458-2939
US

IV. Provider business mailing address

2375 GAUSE BLVD E
SLIDELL LA
70461-4142
US

V. Phone/Fax

Practice location:
  • Phone: 985-280-8743
  • Fax: 985-280-8554
Mailing address:
  • Phone: 985-280-8743
  • Fax: 985-280-8554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN117335
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08191
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: