Provider Demographics
NPI:1255721619
Name:LEMOINE, JACKLYN LEE (APRN)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:LEE
Last Name:LEMOINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:LEE
Other - Last Name:LEMOINE-LOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:DEPT AT952639
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31192-2639
Mailing Address - Country:US
Mailing Address - Phone:225-765-7163
Mailing Address - Fax:
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:ER DEPT
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-7163
Practice Address - Fax:405-844-1794
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily