MEDICARE: AMBER RENE JARRELL MD

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	208000000X	Pediatrics Physician	U5134	TX
2	2080B0002X	Pediatric Obesity Medicine Physician	350021	LA
3	208000000X	Pediatrics Physician	350021	LA

General Provider Information

NPI Number	:	1700406774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER RENE JARRELL MD

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	:	225-765-5500
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	8200 CONSTANTIN BLVD FL 4
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3481
Country	:	US
Telephone Number	:	225-765-5500
Fax Number	:	225-374-1678

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

Provider Enumeration Date	:	04/20/2020
Last Update Date	:	06/01/2026

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