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NPI Code Detail

MEDICARE: KORI FOGG JUBAN

MEDICARE: KORI FOGG JUBAN
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
1363L00000XNurse PractitionerAP09218LA

General Provider Information

NPI Number : 1346761301
Entity Type Code : Individual
Provider Name (Legal Business Name) : KORI FOGG JUBAN
Provider Business Mailing Address
First Line : 5959 S SHERWOOD FOREST BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70816-6038
Country : US
Telephone Number : 225-765-5727
Fax Number : 225-765-9196
Provider Business Practice Location Address
First Line : 5000 ODONAVAN BLVD STE 404
Second Line :
City : WALKER
State : LA
Zip : 70785-6355
Country : US
Telephone Number : 225-369-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2017
Last Update Date : 03/30/2021

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Directions to “ KORI FOGG JUBAN ” Practice Location

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