Provider Demographics
NPI:1649594441
Name:RODRIGUE, JENNIFER D (PNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N ACADIA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-448-3700
Mailing Address - Fax:985-448-3900
Practice Address - Street 1:604 N ACADIA RD STE 200
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4897
Practice Address - Country:US
Practice Address - Phone:985-448-3700
Practice Address - Fax:985-448-3900
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103839-AP06067363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2104535Medicaid