Individual
JILL VAUGHAN RENEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10374 US 165, STERLINGTON, LA 71280-0159
(318) 665-9950
Mailing address
PO BOX 159, FAIRBANKS, LA 71240-0159
(318) 366-9918
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200484.RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2304747
—
LA
Enumeration date
07/21/2011
Last updated
09/09/2016
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