Provider Demographics
NPI:1548705809
Name:COMBS, JANSEN
Entity type:Individual
Prefix:
First Name:JANSEN
Middle Name:
Last Name:COMBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-3767
Mailing Address - Country:US
Mailing Address - Phone:225-778-6783
Mailing Address - Fax:
Practice Address - Street 1:10203 BALLINA AVE
Practice Address - Street 2:APT. D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4478
Practice Address - Country:US
Practice Address - Phone:225-773-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator