MEDICARE: JENNA SEETS FNP-C

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
1	363LF0000X	Family Nurse Practitioner	200272	LA

General Provider Information

NPI Number	:	1023585635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA SEETS FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1288
Second Line	:
City	:	WINNFIELD
State	:	LA
Zip	:	71483-1288
Country	:	US
Telephone Number	:	318-209-4510
Fax Number	:	318-209-4519

Provider Business Practice Location Address
First Line	:	2826 BIENVILLE RD
Second Line	:
City	:	RINGGOLD
State	:	LA
Zip	:	71068-2588
Country	:	US
Telephone Number	:	318-894-2341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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