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NPI Code Detail

MEDICARE: MR. CHRISTOPHER TODD JEANSONNE FNP

MEDICARE: MR. CHRISTOPHER TODD JEANSONNE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP08004LA

General Provider Information

NPI Number : 1023427440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER TODD JEANSONNE FNP
Provider Business Mailing Address
First Line : 409 BENOIT RD
Second Line :
City : CARENCRO
State : LA
Zip : 70520-6116
Country : US
Telephone Number : 318-419-4029
Fax Number :
Provider Business Practice Location Address
First Line : 2912 JOHNSTON ST
Second Line :
City : LAFAYETTE
State : LA
Zip : 70503-3246
Country : US
Telephone Number : 337-456-3519
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2014
Last Update Date : 08/11/2014

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