Provider Demographics
NPI:1245553593
Name:ROY, JENA MILLER (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENA
Middle Name:MILLER
Last Name:ROY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 STAGG AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BASILE
Mailing Address - State:LA
Mailing Address - Zip Code:70515-5560
Mailing Address - Country:US
Mailing Address - Phone:337-432-5552
Mailing Address - Fax:337-432-5553
Practice Address - Street 1:2932 STAGG AVE
Practice Address - Street 2:STE A
Practice Address - City:BASILE
Practice Address - State:LA
Practice Address - Zip Code:70515-5560
Practice Address - Country:US
Practice Address - Phone:337-432-5552
Practice Address - Fax:337-432-5553
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN115486-AP06059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2116479Medicaid
LA3B933DU88Medicare PIN