Organization
JENNINGS PEDIATRIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIKKI D MONCEAUX (OFFICE NURSE)
(337) 824-3446
Entity
Organization
Contact information
Practice address
1615 JOHNSON ST STE A, JENNINGS, LA 70546-3650
(337) 824-3446
(337) 824-7990
Mailing address
1615 JOHNSON ST STE A, JENNINGS, LA 70546-3650
(337) 824-3446
(337) 824-7990
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
08542R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649651571
—
LA
Enumeration date
09/26/2017
Last updated
09/12/2025
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