Provider Demographics
NPI:1578896122
Name:BATSON, JERRY WILSON (RN, C-FNP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:WILSON
Last Name:BATSON
Suffix:
Gender:M
Credentials:RN, C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-2125
Mailing Address - Country:US
Mailing Address - Phone:318-396-0729
Mailing Address - Fax:
Practice Address - Street 1:300 PAVILION RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-9470
Practice Address - Country:US
Practice Address - Phone:318-323-1100
Practice Address - Fax:318-332-1161
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01729542Medicaid
LA1808334Medicaid