Healthcare Provider Details

I. General information

NPI: 1104290881
Provider Name (Legal Business Name): JAMIE BAYHAM ST. ROMAIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S 2ND ST
EUNICE LA
70535-4608
US

IV. Provider business mailing address

102 S 2ND ST
EUNICE LA
70535-4608
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-3135
  • Fax:
Mailing address:
  • Phone: 337-457-3135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08292
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: