Provider Demographics
NPI:1255323390
Name:BENNETT, JENNIFER GAY (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GAY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 ROACH RD
Mailing Address - Street 2:
Mailing Address - City:CHOUDRANT
Mailing Address - State:LA
Mailing Address - Zip Code:71227-3633
Mailing Address - Country:US
Mailing Address - Phone:318-366-7128
Mailing Address - Fax:
Practice Address - Street 1:5975 FEDERAL HWY 80
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2957
Practice Address - Country:US
Practice Address - Phone:318-728-2046
Practice Address - Fax:318-728-9371
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily