Healthcare Provider Details

I. General information

NPI: 1093010928
Provider Name (Legal Business Name): JEWELL SURGICAL SERVICES, APNC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14321 VENTRESS RD
VENTRESS LA
70783-4005
US

IV. Provider business mailing address

14321 VENTRESS RD
VENTRESS LA
70783-4005
US

V. Phone/Fax

Practice location:
  • Phone: 225-978-3754
  • Fax:
Mailing address:
  • Phone: 225-978-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN103777
License Number StateLA

VIII. Authorized Official

Name: KAYLII MELANCON JEWELL
Title or Position: PRESIDENT
Credential: RN, BSN, CNOR, RNFA
Phone: 225-978-3754