Provider Demographics
NPI:1164686697
Name:EDU, JENNY MARTIN (NP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARTIN
Last Name:EDU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 WATTS ST STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71251-2063
Mailing Address - Country:US
Mailing Address - Phone:318-259-5636
Mailing Address - Fax:318-259-5640
Practice Address - Street 1:121 WATTS ST STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-2063
Practice Address - Country:US
Practice Address - Phone:318-259-5636
Practice Address - Fax:318-259-5640
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05527363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05527OtherADVANCED PRACTICE REGISTERED NURSE