Provider Demographics
NPI:1902160237
Name:PENTON, JANICE N (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:N
Last Name:PENTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438-3688
Mailing Address - Country:US
Mailing Address - Phone:985-839-3555
Mailing Address - Fax:985-839-6320
Practice Address - Street 1:806-B RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438-3688
Practice Address - Country:US
Practice Address - Phone:985-839-3555
Practice Address - Fax:985-839-6320
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2346440Medicaid
315167YR4BOtherMEDICARE PROVIDER NUMBER