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General NPI Number Information
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NPI Number | 1457016628
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Entity Type | Individual
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Provider Name | JENNIFER M STARK
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 1402 S MAGNOLIA ST STE K
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City | HAMMOND
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State | LA
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Zip | 70403-5020
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Country | US
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Telephone | 985-956-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 BELLECASTLE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-3030
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Country | US
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Telephone | 504-920-9488
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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 | 220613
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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 | 220613
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License Number State | LA
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