Provider Demographics
NPI:1376587014
Name:ST. ROMAIN, JENNIFER (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ST. ROMAIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-2601
Mailing Address - Country:US
Mailing Address - Phone:985-229-5501
Mailing Address - Fax:985-229-5828
Practice Address - Street 1:721 AVENUE G
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2601
Practice Address - Country:US
Practice Address - Phone:985-229-5501
Practice Address - Fax:985-229-6828
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04910363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369667Medicaid