Provider Demographics
NPI:1912138280
Name:JETER, AMELIA C (NP)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:C
Last Name:JETER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:104 MORRIS CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-2100
Mailing Address - Country:US
Mailing Address - Phone:318-927-1110
Mailing Address - Fax:318-927-1116
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2100
Practice Address - Country:US
Practice Address - Phone:318-927-6777
Practice Address - Fax:318-927-6714
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2178363LF0000X
LAAP05936363LF0000X
LARN073583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily