MEDICARE: MRS. GRACE BOURGEOIS DUFRENE FNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	226264	LA
2	163W00000X	Registered Nurse	RN139058	LA
3	363LF0000X	Family Nurse Practitioner	226264	LA

General Provider Information

NPI Number	:	1205178217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE BOURGEOIS DUFRENE FNP

Provider Business Mailing Address
First Line	:	302 HACKER ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-4508
Country	:	US
Telephone Number	:	337-330-2576
Fax Number	:	337-321-6295

Provider Business Practice Location Address
First Line	:	1119 N MAIN ST
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-7774
Fax Number	:	337-394-8015

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	01/26/2026

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