Provider Demographics
NPI:1780211607
Name:ROY, JENNIFER STEVENSON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STEVENSON
Last Name:ROY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 PINE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-3122
Mailing Address - Country:US
Mailing Address - Phone:318-263-7970
Mailing Address - Fax:
Practice Address - Street 1:1175 PINE ST STE 100
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3122
Practice Address - Country:US
Practice Address - Phone:318-263-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA212082363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily