Provider Demographics
NPI:1942998927
Name:JENNINGS, SHIRLETTE
Entity Type:Individual
Prefix:
First Name:SHIRLETTE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26958 HAYNES SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-8642
Mailing Address - Country:US
Mailing Address - Phone:225-446-7222
Mailing Address - Fax:
Practice Address - Street 1:26958 HAYNES SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462-8642
Practice Address - Country:US
Practice Address - Phone:985-510-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)