Provider Demographics
NPI:1770118374
Name:PELLEGRINI, JOURDAN
Entity type:Individual
Prefix:
First Name:JOURDAN
Middle Name:
Last Name:PELLEGRINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOURDAN
Other - Middle Name:
Other - Last Name:MCELROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-3668
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1436
Practice Address - Country:US
Practice Address - Phone:985-230-1683
Practice Address - Fax:985-230-6652
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily