Individual
MS. JESSICA FUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9440 MAIN ST, ZACHARY, LA 70791-7440
(225) 603-7262
Mailing address
2585 BRIGHTSIDE DR, BATON ROUGE, LA 70820-3504
(225) 603-7262
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
RN162126
LA
163WS0200X
School Registered Nurse
RN162126
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1376014100
—
LA
Enumeration date
02/23/2021
Last updated
02/23/2021
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