Provider Demographics
NPI:1265111207
Name:SMITH, JENNA LYNN (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CYPRESS POINT LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006-8670
Mailing Address - Country:US
Mailing Address - Phone:318-426-0465
Mailing Address - Fax:
Practice Address - Street 1:255 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8150
Practice Address - Country:US
Practice Address - Phone:318-683-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128686363L00000X
LA231111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner