Provider Demographics
NPI:1376015735
Name:JONES, LUCIE JHOLEH (NP)
Entity Type:Individual
Prefix:
First Name:LUCIE
Middle Name:JHOLEH
Last Name:JONES
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:PO BOX 4506
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71134-0506
Mailing Address - Country:US
Mailing Address - Phone:318-239-4860
Mailing Address - Fax:805-295-4715
Practice Address - Street 1:2106 LOOP RD STE B
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3343
Practice Address - Country:US
Practice Address - Phone:318-239-4860
Practice Address - Fax:805-295-4715
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203276363L00000X
LARN147445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2543776Medicaid