1497752018 NPI number — JUDY ANNE JAMESON RN, MSN, C-FNP

Table of content: JUDY ANNE JAMESON RN, MSN, C-FNP (NPI 1497752018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497752018 NPI number — JUDY ANNE JAMESON RN, MSN, C-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAMESON
Provider First Name:
JUDY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, C-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497752018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 JOE ROSIER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71328-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-466-3649
Provider Business Mailing Address Fax Number:
318-466-5803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 SHREVEPORT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-473-0010
Provider Business Practice Location Address Fax Number:
318-483-5202
Provider Enumeration Date:
06/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  655243327 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 655243327 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020232 . This is a "DRUG ID#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1560383 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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