Provider Demographics
NPI:1801082920
Name:ANDERSON, JESSICA CARTER (WHNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CARTER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:WHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 SHED RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5662
Mailing Address - Country:US
Mailing Address - Phone:318-935-1922
Mailing Address - Fax:318-935-1925
Practice Address - Street 1:5751 SHED RD STE 120
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5662
Practice Address - Country:US
Practice Address - Phone:318-935-1922
Practice Address - Fax:318-935-1925
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN110685363LX0001X
LAAP05293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1022349Medicaid
LA5CS96Medicare PIN
LA1022349Medicaid