Provider Demographics
NPI:1366686883
Name:NGUYEN, JESSICA MINH (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-896-9569
Mailing Address - Fax:504-896-9849
Practice Address - Street 1:200 HENRY CLAY AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5720
Practice Address - Country:US
Practice Address - Phone:504-896-9569
Practice Address - Fax:504-896-9849
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200261.RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPA.200261.RXOtherLA STATE BRD OF MEDICAL EXAMINERS LICENSE
PAMA054864OtherPA STATE BOARD OF MEDICINE
LAPA.200261.RXOtherLA STATE BRD OF MEDICAL EXAMINERS LICENSE