Provider Demographics
NPI:1780297234
Name:OSBORNE, JENNIFER S (ACNPC-AG)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:S
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3908
Mailing Address - Country:US
Mailing Address - Phone:318-212-4000
Mailing Address - Fax:
Practice Address - Street 1:2551 GREENWOOD RD STE 210
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3985
Practice Address - Country:US
Practice Address - Phone:318-635-0834
Practice Address - Fax:318-636-2331
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215455363LC0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner