Provider Demographics
NPI:1639499932
Name:JGC-NP, LLC
Entity Type:Organization
Organization Name:JGC-NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:CHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-928-2468
Mailing Address - Street 1:4040 NORTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3829
Mailing Address - Country:US
Mailing Address - Phone:225-928-2468
Mailing Address - Fax:
Practice Address - Street 1:4040 NORTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3829
Practice Address - Country:US
Practice Address - Phone:225-928-2468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06115163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty