Individual
KORI FOGG JUBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5000 ODONAVAN BLVD STE 404, WALKER, LA 70785-6355
(225) 369-8100
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 765-5727
(225) 765-9196
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP09218
LA
Other
Enumeration date
06/29/2017
Last updated
03/30/2021
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