Provider Demographics
NPI:1538189881
Name:DENSON, BOBBY GENE JR (FNP-C)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:GENE
Last Name:DENSON
Suffix:JR
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-3628
Mailing Address - Country:US
Mailing Address - Phone:985-632-5222
Mailing Address - Fax:985-632-4222
Practice Address - Street 1:102 W 112TH ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-3628
Practice Address - Country:US
Practice Address - Phone:985-632-5222
Practice Address - Fax:985-632-4222
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660485Medicaid
LAC73872Medicare UPIN
LA1660485Medicaid