Provider Demographics
NPI:1770762668
Name:DUCK, JENNIFER LYNN (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DUCK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4063
Mailing Address - Country:US
Mailing Address - Phone:337-364-3301
Mailing Address - Fax:337-364-9689
Practice Address - Street 1:2309 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4063
Practice Address - Country:US
Practice Address - Phone:337-364-3301
Practice Address - Fax:337-364-9689
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C344P905Medicare PIN