Individual
JESSICA MORAN SUIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
100 MEDICAL CENTER DR, SLIDELL, LA 70461-5520
(985) 646-5750
Mailing address
9536 KOLO WAY, DIAMONDHEAD, MS 39525-4119
(228) 332-1484
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP08853
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04637823
—
MS
05
—
2426681
—
LA
Enumeration date
06/14/2016
Last updated
10/31/2016
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