Provider Demographics
NPI:1194027102
Name:BLACK-TURNER, JENEEN A (APRN)
Entity type:Individual
Prefix:
First Name:JENEEN
Middle Name:A
Last Name:BLACK-TURNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 DARNALL RD
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-0459
Mailing Address - Country:US
Mailing Address - Phone:337-706-8986
Mailing Address - Fax:337-706-8712
Practice Address - Street 1:3414 MOSS ST
Practice Address - Street 2:SUITE F
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-6107
Practice Address - Country:US
Practice Address - Phone:337-706-8986
Practice Address - Fax:337-706-8712
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily