1245553593 NPI number — MRS. JENA MILLER ROY FNP-BC

Table of content: MRS. JENA MILLER ROY FNP-BC (NPI 1245553593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245553593 NPI number — MRS. JENA MILLER ROY FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROY
Provider First Name:
JENA
Provider Middle Name:
MILLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
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:
1245553593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2932 STAGG AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
BASILE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70515-5560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-432-5552
Provider Business Mailing Address Fax Number:
337-432-5553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2932 STAGG AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BASILE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70515-5560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-432-5552
Provider Business Practice Location Address Fax Number:
337-432-5553
Provider Enumeration Date:
03/01/2010

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: 363LF0000X , with the licence number:  RN115486-AP06059 , 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: 2116479 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com