=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831190321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER BELLO VOSBURG PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2005
-----------------------------------------------------
Last Update Date | 03/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6550 MAIN ST STE 1000
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-654-1559
-----------------------------------------------------
Fax | 225-654-6212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6550 MAIN ST STE 1000
-----------------------------------------------------
City | ZACHARY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70791-4092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-654-1559
-----------------------------------------------------
Fax | 225-654-6212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA.A10454.RX
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------