Healthcare Provider Details

I. General information

NPI: 1942167754
Provider Name (Legal Business Name): LAWRENCE JOSEPH HEBERT III FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W 112TH ST
CUT OFF LA
70345-3628
US

IV. Provider business mailing address

102 W 112TH ST
CUT OFF LA
70345-3628
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-5222
  • Fax:
Mailing address:
  • Phone: 985-632-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number245548
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number142174
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: