Provider Demographics
NPI:1063061950
Name:HARRISON, JODIE DIANE (AGNP-C)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:DIANE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:DIANE
Other - Last Name:CATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1120 ROBERT BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2069
Practice Address - Country:US
Practice Address - Phone:985-646-2411
Practice Address - Fax:985-646-2413
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAG09190008363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology