Individual
MRS. JESSICA PETRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
206 ENERGY PARKWAY, LAFAYETTE, LA 70508-3816
(337) 504-3335
(337) 504-4795
Mailing address
206 ENERGY PARKWAY, LAFAYETTE, LA 70508-3816
(337) 504-3335
(337) 504-4795
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
303881
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2390732
—
LA
Enumeration date
04/13/2015
Last updated
03/07/2024
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