Healthcare Provider Details

I. General information

NPI: 1114377124
Provider Name (Legal Business Name): JEREMY BRANDON COURVILLE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 LA HIGHWAY 1
BATCHELOR LA
70715-3212
US

IV. Provider business mailing address

1786 BEAUREGARD RD
SIMMESPORT LA
71369-2336
US

V. Phone/Fax

Practice location:
  • Phone: 225-492-3775
  • Fax: 225-492-3782
Mailing address:
  • Phone: 318-240-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08838
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: