Provider Demographics
NPI:1134543705
Name:ANDERSON, JESSICA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIE
Last Name:ANDERSON
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 1:2221 PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2525
Mailing Address - Country:US
Mailing Address - Phone:504-568-3130
Mailing Address - Fax:
Practice Address - Street 1:2221 PHILIP ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113
Practice Address - Country:US
Practice Address - Phone:504-568-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205925363LA2200X
MNR1809802363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health