Provider Demographics
NPI:1093010928
Name:JEWELL SURGICAL SERVICES, APNC
Entity Type:Organization
Organization Name:JEWELL SURGICAL SERVICES, APNC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLII
Authorized Official - Middle Name:MELANCON
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CNOR, RNFA
Authorized Official - Phone:225-978-3754
Mailing Address - Street 1:14321 VENTRESS RD
Mailing Address - Street 2:
Mailing Address - City:VENTRESS
Mailing Address - State:LA
Mailing Address - Zip Code:70783-4005
Mailing Address - Country:US
Mailing Address - Phone:225-978-3754
Mailing Address - Fax:
Practice Address - Street 1:14321 VENTRESS RD
Practice Address - Street 2:
Practice Address - City:VENTRESS
Practice Address - State:LA
Practice Address - Zip Code:70783-4005
Practice Address - Country:US
Practice Address - Phone:225-978-3754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103777163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty