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General NPI Number Information
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NPI Number | 1417436700
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Entity Type | Individual
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Provider Name | JENNIFER MARIE LANDRY FNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 4150 NELSON RD
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City | LAKE CHARLES
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State | LA
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Zip | 70605-4148
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Country | US
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Telephone | 337-656-7872
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 JEFFERSON HWY
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City | NEW ORLEANS
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State | LA
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Zip | 70121-2429
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Country | US
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Telephone | 504-842-4000
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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 | 10062
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP10062
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License Number State | LA
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