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General NPI Number Information
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NPI Number | 1164686697
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Entity Type | Individual
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Provider Name | JENNY MARTIN EDU NP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 121 WATTS ST STE A
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City | JONESBORO
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State | LA
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Zip | 71251-2063
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Country | US
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Telephone | 318-259-5636
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Fax | 318-259-5640
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Provider Business Mailing Address
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Address Line | 121 WATTS ST STE A
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City | JONESBORO
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State | LA
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Zip | 71251-2063
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Country | US
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Telephone | 318-259-5636
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Fax | 318-259-5640
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP05527
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License Number State | LA
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