Provider Demographics
NPI:1356083018
Name:SAMPSON, JEROMONE C SR
Entity Type:Individual
Prefix:MR
First Name:JEROMONE
Middle Name:C
Last Name:SAMPSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 TEDDY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1925
Mailing Address - Country:US
Mailing Address - Phone:225-218-4444
Mailing Address - Fax:225-448-3000
Practice Address - Street 1:3040 TEDDY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1925
Practice Address - Country:US
Practice Address - Phone:225-218-4444
Practice Address - Fax:225-448-3000
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator