Provider Demographics
NPI:1780815985
Name:HART, JENNIFER CAMERON (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAMERON
Last Name:HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5948 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2017
Mailing Address - Country:US
Mailing Address - Phone:318-375-0001
Mailing Address - Fax:318-375-0002
Practice Address - Street 1:5948 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2017
Practice Address - Country:US
Practice Address - Phone:318-375-0001
Practice Address - Fax:318-375-0002
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN110584APO5876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2197711Medicaid
LAAP05876OtherLICENSE