Healthcare Provider Details

I. General information

NPI: 1295408698
Provider Name (Legal Business Name): DUSTIN HEBERT PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5599 HIGHWAY 311
HOUMA LA
70360-2866
US

IV. Provider business mailing address

10396 E PARK AVE
HOUMA LA
70363-3889
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-3615
  • Fax: 985-857-3765
Mailing address:
  • Phone: 985-860-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number221349
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: