Individual
JENNIFER TAYLOR GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
2770 3RD AVE STE 350, LAKE CHARLES, LA 70601-0404
(337) 494-2750
(337) 494-2760
Mailing address
PO BOX 122309 DEPT 2309, DALLAS, TX 75312-0001
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP06581
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2530984
—
LA
01
—
AP06581
STATE LICENSE
LA
Enumeration date
06/20/2012
Last updated
04/27/2022
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