Provider Demographics
NPI:1962267922
Name:CHOUDRANT PRIMARY CARE LLC
Entity type:Organization
Organization Name:CHOUDRANT PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:318-695-9200
Mailing Address - Street 1:216 LOBLOLLY LN
Mailing Address - Street 2:
Mailing Address - City:CHOUDRANT
Mailing Address - State:LA
Mailing Address - Zip Code:71227-4804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3845 ELM ST STE 3
Practice Address - Street 2:
Practice Address - City:CHOUDRANT
Practice Address - State:LA
Practice Address - Zip Code:71227-3017
Practice Address - Country:US
Practice Address - Phone:318-695-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty