Provider Demographics
NPI:1265976617
Name:MIDGETT, JENNIFER DIANNE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANNE
Last Name:MIDGETT
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 1:300 LEE NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2581 HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634
Practice Address - Country:US
Practice Address - Phone:337-221-3075
Practice Address - Fax:337-221-3076
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily