MEDICARE: JARED BRABHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN158835	LA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	234094	LA

General Provider Information

NPI Number	:	1134763576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED BRABHAM

Provider Business Mailing Address
First Line	:	4105 KIRKMAN ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4603
Country	:	US
Telephone Number	:	337-475-3100
Fax Number	:	337-475-3105

Provider Business Practice Location Address
First Line	:	2651 E NAPOLEON ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-3707
Country	:	US
Telephone Number	:	337-625-6750
Fax Number	:	337-625-6752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	11/10/2025

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Directions to “ JARED BRABHAM ” Practice Location

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