Healthcare Provider Details

I. General information

NPI: 1366282857
Provider Name (Legal Business Name): RYAN HEBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

IV. Provider business mailing address

235 CIVIC CENTER BLVD
HOUMA LA
70360-5937
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-2020
  • Fax: 985-851-0452
Mailing address:
  • Phone: 985-333-2020
  • Fax: 985-851-0162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235632
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: