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Individual

JENNA ELIZABETH PENTECOST WILLIFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3802 PRESCOTT RD., ALEXANDRIA, LA 71301
(318) 487-6060
(318) 487-0406
Mailing address
3802 PRESCOTT RD., ALEXANDRIA, LA 71301
(318) 487-6060
(318) 487-0406

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200555
LA
363AM0700X
Medical Physician Assistant
PA 200555
LA

Other

Enumeration date
10/04/2012
Last updated
03/05/2014
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