Healthcare Provider Details

I. General information

NPI: 1124403001
Provider Name (Legal Business Name): JADE DUPRE CARRERE AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 BELANGER ST STE 107
HOUMA LA
70360
US

IV. Provider business mailing address

855 BELANGER ST STE 107
HOUMA LA
70360-4463
US

V. Phone/Fax

Practice location:
  • Phone: 985-851-0059
  • Fax:
Mailing address:
  • Phone: 985-851-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR899678
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR899678
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: