Provider Demographics
NPI:1629328133
Name:MOSER, JENNIFER WAY (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WAY
Last Name:MOSER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SCOTT
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Former Name
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:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 709
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-7735
Practice Address - Fax:225-765-1023
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317172Medicaid
259295Medicare PIN
LA2317172Medicaid