Provider Demographics
NPI:1740769082
Name:JENNIFER MIDGETT, LLC
Entity Type:Organization
Organization Name:JENNIFER MIDGETT, LLC
Other - Org Name:PREMIER PEDIATRICS OF LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDGETT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:337-221-3075
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-1146
Mailing Address - Country:US
Mailing Address - Phone:337-221-3075
Mailing Address - Fax:337-221-3076
Practice Address - Street 1:2581 HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-6056
Practice Address - Country:US
Practice Address - Phone:337-221-3075
Practice Address - Fax:337-221-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty