Healthcare Provider Details

I. General information

NPI: 1235512666
Provider Name (Legal Business Name): BEAU JAMES LEONARD A.P.R.N., F.N.P.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 W TUNNEL BLVD
HOUMA LA
70360
US

IV. Provider business mailing address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

V. Phone/Fax

Practice location:
  • Phone: 985-851-1717
  • Fax: 985-851-7183
Mailing address:
  • Phone: 337-828-2550
  • Fax: 337-828-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08387
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP08387
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN123903
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: