Provider Demographics
NPI:1083909915
Name:LAWRENCE, JERETA JAMES (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JERETA
Middle Name:JAMES
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OWENS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-1349
Mailing Address - Country:US
Mailing Address - Phone:318-614-2758
Mailing Address - Fax:
Practice Address - Street 1:3402 MAGNOLIA CV
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2374
Practice Address - Country:US
Practice Address - Phone:318-812-1250
Practice Address - Fax:318-322-1249
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily