1912145640 NPI number — DR. TIFFANY ANN JENNINGS PSYD

Table of content: SEAN B BAILEY M.D. (NPI 1013908714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912145640 NPI number — DR. TIFFANY ANN JENNINGS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENNINGS
Provider First Name:
TIFFANY
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1912145640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 WHITE OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-6708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-527-3535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 PIERREMONT RD
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71106-2093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-606-4785
Provider Business Practice Location Address Fax Number:
866-786-4201
Provider Enumeration Date:
02/03/2009

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: 103TC0700X , with the licence number:  1148 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103G00000X , with the licence number: 1148 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 1148 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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