Provider Demographics
NPI:1497752018
Name:JAMESON, JUDY ANNE (RN, MSN, C-FNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANNE
Last Name:JAMESON
Suffix:
Gender:F
Credentials:RN, MSN, C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 JOE ROSIER RD
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-9027
Mailing Address - Country:US
Mailing Address - Phone:318-466-3649
Mailing Address - Fax:318-466-5803
Practice Address - Street 1:2495 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-473-0010
Practice Address - Fax:318-483-5202
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA655243327363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020232OtherDRUG ID#
LA1560383Medicaid
LA5P024Medicare ID - Type Unspecified
LA1560383Medicaid