Healthcare Provider Details

I. General information

NPI: 1366187858
Provider Name (Legal Business Name): JOSE ALE AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 HIGHWAY 23
BELLE CHASSE LA
70037-2607
US

IV. Provider business mailing address

2900 INDIANA AVE
KENNER LA
70065-4605
US

V. Phone/Fax

Practice location:
  • Phone: 866-530-6111
  • Fax:
Mailing address:
  • Phone: 504-575-3712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225741
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number225741
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: