Provider Demographics
NPI:1841879129
Name:KAVANAUGH, JEANNE DANOS (AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:DANOS
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2474
Mailing Address - Country:US
Mailing Address - Phone:985-871-5975
Mailing Address - Fax:
Practice Address - Street 1:1010 S POLK ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2474
Practice Address - Country:US
Practice Address - Phone:985-871-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218852363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology