=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477537066
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE ANN SCHEXNYDER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 HIGHWAY 72 S
-----------------------------------------------------
City | LECOMPTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71360-7134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-466-2105
-----------------------------------------------------
Fax | 318-483-5117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 124
-----------------------------------------------------
City | LECOMPTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71346-0124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-729-6003
-----------------------------------------------------
Fax | 318-483-5117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AP04075
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------