Provider Demographics
NPI:1407374754
Name:NEIDIGH, JENNY REBECCA (CRNP)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:REBECCA
Last Name:NEIDIGH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 IROQUOIAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4940
Mailing Address - Country:US
Mailing Address - Phone:337-905-6895
Mailing Address - Fax:337-905-6896
Practice Address - Street 1:711 IROQUOIAN DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611
Practice Address - Country:US
Practice Address - Phone:337-905-6895
Practice Address - Fax:337-905-6896
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018169363L00000X
LA204668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner