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General NPI Number Information
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NPI Number | 1265710982
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Entity Type | Organization
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Legal Business Name | JENA M. ROY FNP LLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 2932 STAGG AVE STE A
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City | BASILE
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State | LA
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Zip | 70515-5560
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Country | US
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Telephone | 337-432-5552
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Fax | 337-432-5553
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Provider Business Mailing Address
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Address Line | 2932 STAGG AVE STE A
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City | BASILE
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State | LA
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Zip | 70515-5560
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Country | US
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Telephone | 337-432-5552
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Fax | 337-432-5553
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENA MILLER ROY
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Credential | FNP-BC
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Telephone | 337-432-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP06059
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License Number State | LA
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