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General NPI Number Information
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NPI Number | 1821507542
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Entity Type | Organization
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Legal Business Name | JENNINGS PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 09/26/2017
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1615 JOHNSON ST STE A
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City | JENNINGS
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State | LA
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Zip | 70546-3650
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Country | US
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Telephone | 337-824-3446
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Fax | 337-824-7990
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Provider Business Mailing Address
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Address Line | 1615 JOHNSON ST STE A
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City | JENNINGS
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State | LA
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Zip | 70546-3650
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Country | US
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Telephone | 337-824-3446
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Fax | 337-824-7990
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Authorized Official
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Title or Position | OFFICE NURSE
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Name | MRS. MIKKI D MONCEAUX
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Credential |
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Telephone | 337-824-3446
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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 | 08542R
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License Number State | LA
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