Healthcare Provider Details

I. General information

NPI: 1316683709
Provider Name (Legal Business Name): JAMIE MATTA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N THEARD ST
COVINGTON LA
70433-2835
US

IV. Provider business mailing address

146 REIHER RD
MANDEVILLE LA
70471-7261
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-2276
  • Fax:
Mailing address:
  • Phone: 985-264-3875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN121986
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: