Provider Demographics
NPI:1902007123
Name:MYERS, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5181
Mailing Address - Country:US
Mailing Address - Phone:337-456-3323
Mailing Address - Fax:337-456-4638
Practice Address - Street 1:5701 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5181
Practice Address - Country:US
Practice Address - Phone:337-456-3323
Practice Address - Fax:337-456-4638
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202110207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00740193OtherPALMETTO GBA - RAILROAD MEDICARE
LA0332210001Medicare NSC
LA4M0237191Medicare PIN