Provider Demographics
NPI:1780852962
Name:LEVINSON, JENNIFER (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:LEVINSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0445
Mailing Address - Country:US
Mailing Address - Phone:318-436-2600
Mailing Address - Fax:318-436-2601
Practice Address - Street 1:612 S. FARMERVILLE STREET
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:318-436-2600
Practice Address - Fax:318-436-2601
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05230363LP0200X
LARN099522163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse