Healthcare Provider Details

I. General information

NPI: 1881989572
Provider Name (Legal Business Name): JAMIE M ROQUES APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

4615 GOVERNMENT ST
BATON ROUGE LA
70806-5922
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5903
Mailing address:
  • Phone: 225-922-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP01821
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: