Healthcare Provider Details

I. General information

NPI: 1376841403
Provider Name (Legal Business Name): YOUSELINE JEAN-LOUIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42D MEDICAL GROUP 300 S. TWINING ST., BLDG 760
MAXWELL AFB AL
36112
US

IV. Provider business mailing address

MAXWELL MEDICAL GROUP 300 S. TWINING ST., BLDG 760
MAXWELL AFB AL
36112
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5200
  • Fax:
Mailing address:
  • Phone: 334-953-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2264439
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2264439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: