Healthcare Provider Details

I. General information

NPI: 1972407583
Provider Name (Legal Business Name): JIMMY BADON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 W TUNNEL BLVD STE 300
HOUMA LA
70360-2827
US

IV. Provider business mailing address

3535 WALTER DR
SLIDELL LA
70458-4947
US

V. Phone/Fax

Practice location:
  • Phone: 985-709-0029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: