Provider Demographics
NPI:1629328133
Name:WAY, JENNIFER SCOTT (APRN, FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SCOTT
Last Name:WAY
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:WAY
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-7735
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:7777 HENNESSY BLVD STE 709
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4366
Practice Address - Country:US
Practice Address - Phone:225-765-7735
Practice Address - Fax:225-765-1023
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317172Medicaid
259295Medicare PIN
LA2317172Medicaid