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General NPI Number Information
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NPI Number | 1144829540
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Entity Type | Individual
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Provider Name | JENNA NICOLE BLUNDELL FNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 1811 E BERT KOUNS INDUSTRIAL LOOP STE 210
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City | SHREVEPORT
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State | LA
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Zip | 71105-5740
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Country | US
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Telephone | 318-212-3858
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Fax |
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Provider Business Mailing Address
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Address Line | 122 RAGAN LN
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City | HAUGHTON
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State | LA
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Zip | 71037-8994
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Country | US
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Telephone | 641-990-3361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 216026
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License Number State | LA
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