Healthcare Provider Details

I. General information

NPI: 1801713052
Provider Name (Legal Business Name): JERRICA VATIEL STERRETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 BITTER PECAN DR
BOSSIER CITY LA
71111-5112
US

IV. Provider business mailing address

607 BITTER PECAN DR
BOSSIER CITY LA
71111-5112
US

V. Phone/Fax

Practice location:
  • Phone: 318-780-1610
  • Fax:
Mailing address:
  • Phone: 318-780-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248053
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: