Provider Demographics
NPI:1245714997
Name:CARPRUE, JALEESA CHANTELL
Entity type:Individual
Prefix:
First Name:JALEESA
Middle Name:CHANTELL
Last Name:CARPRUE
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 1:3157 GENTILLY BLVD STE 2035
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3872
Mailing Address - Country:US
Mailing Address - Phone:888-884-6520
Mailing Address - Fax:
Practice Address - Street 1:5000 FORSYTHE BYP STE 114
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2168
Practice Address - Country:US
Practice Address - Phone:318-450-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management