Provider Demographics
NPI:1427560176
Name:JASPER, LISA C
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:JASPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 S STACY AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3829
Mailing Address - Country:US
Mailing Address - Phone:225-253-6325
Mailing Address - Fax:225-282-1000
Practice Address - Street 1:1031 S STACY AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3829
Practice Address - Country:US
Practice Address - Phone:225-253-6325
Practice Address - Fax:225-282-1000
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13666981557Medicaid