Provider Demographics
NPI:1487205076
Name:TRICHELL, JANELLE BOYDSTUN
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:BOYDSTUN
Last Name:TRICHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:BOYDSTUN
Other - Last Name:TRICHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1039 JENNIFERS PL
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-2750
Mailing Address - Country:US
Mailing Address - Phone:318-290-9188
Mailing Address - Fax:
Practice Address - Street 1:1039 JENNIFERS PL
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-2750
Practice Address - Country:US
Practice Address - Phone:318-290-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA99499Medicaid
LA99499OtherSAMARITAN MINISTRIES