Provider Demographics
NPI:1871697094
Name:VERBURG, JESSICA HALE (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HALE
Last Name:VERBURG
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HALE
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:BUSINESS CTR - INS CREDENTIALING
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1682
Mailing Address - Fax:985-230-6652
Practice Address - Street 1:42440 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2403
Practice Address - Country:US
Practice Address - Phone:985-542-4950
Practice Address - Fax:985-542-6089
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04647363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1527459Medicaid