Healthcare Provider Details

I. General information

NPI: 1528834835
Provider Name (Legal Business Name): PAIGE DECAREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WALL BLVD
GRETNA LA
70056-7107
US

IV. Provider business mailing address

4207 SAINT ELIZABETH DR
KENNER LA
70065-1646
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-2273
  • Fax:
Mailing address:
  • Phone: 225-405-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number244122
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN153233
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: