Healthcare Provider Details

I. General information

NPI: 1962779470
Provider Name (Legal Business Name): JAIME ELLIS GAUDET NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SCHOOL ST
HOUMA LA
70360-4629
US

IV. Provider business mailing address

1001 SCHOOL ST
HOUMA LA
70360-4629
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-1540
  • Fax: 985-876-0759
Mailing address:
  • Phone: 985-868-1540
  • Fax: 985-876-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberCEP11471
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07076
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: