Provider Demographics
NPI:1548418965
Name:TEMPLET, JESSICA HEATH (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HEATH
Last Name:TEMPLET
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8300 CONSTANTIN BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3489
Practice Address - Country:US
Practice Address - Phone:225-763-6337
Practice Address - Fax:225-761-4072
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04244363A00000X
LAPA.200234.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07900879Medicaid
LA1881937Medicaid
LA5BD11PC84Medicare PIN