Provider Demographics
NPI:1578785630
Name:GILKES, JENNIFER SUE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:GILKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 OLD CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8337
Mailing Address - Country:US
Mailing Address - Phone:225-766-7768
Mailing Address - Fax:225-767-6811
Practice Address - Street 1:8414 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2823
Practice Address - Country:US
Practice Address - Phone:225-766-7768
Practice Address - Fax:225-767-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 2008972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAI 39305Medicare UPIN