MEDICARE: PREMIER PEDIATRICS OF LIVINGSTON, LLP

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1841978178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PEDIATRICS OF LIVINGSTON, LLP

Provider Business Mailing Address
First Line	:	35055 LA HIGHWAY 16 STE G
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1535
Country	:	US
Telephone Number	:	225-571-5941
Fax Number	:

Provider Business Practice Location Address
First Line	:	35055 LA HIGHWAY 16 STE G
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1535
Country	:	US
Telephone Number	:	225-571-5941
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	JENNIFER KEPPER
Credential	:	FNP-C
Telephone Number	:	225-571-5941

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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