Provider Demographics
NPI:1093021081
Name:SIRMON, JENNIFER HILLARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HILLARY
Last Name:SIRMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CELIA DR
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4004
Mailing Address - Country:US
Mailing Address - Phone:504-710-6620
Mailing Address - Fax:
Practice Address - Street 1:120 CELIA DR
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4004
Practice Address - Country:US
Practice Address - Phone:504-710-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06796174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist