Provider Demographics
NPI:1720331333
Name:JUNG, ALLISON B (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:B
Last Name:JUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 EMERALD FOREST BLVD
Mailing Address - Street 2:STE H
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5193
Mailing Address - Country:US
Mailing Address - Phone:985-892-3360
Mailing Address - Fax:985-892-3375
Practice Address - Street 1:360 EMERALD FOREST BLVD
Practice Address - Street 2:STE H
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5193
Practice Address - Country:US
Practice Address - Phone:985-892-3360
Practice Address - Fax:985-892-3375
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10407.RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical