Provider Demographics
NPI:1558885160
Name:VIDRINE, JILL (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3985
Mailing Address - Country:US
Mailing Address - Phone:318-448-5310
Mailing Address - Fax:318-448-7110
Practice Address - Street 1:3311 PRESCOTT RD STE 411
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3985
Practice Address - Country:US
Practice Address - Phone:318-448-5310
Practice Address - Fax:318-448-7110
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP09462207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology