Healthcare Provider Details

I. General information

NPI: 1477486231
Provider Name (Legal Business Name): JENNIFER A VEDROS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SCHOOL ST
HOUMA LA
70360-4374
US

IV. Provider business mailing address

PO BOX 25
CUT OFF LA
70345-0025
US

V. Phone/Fax

Practice location:
  • Phone: 985-333-3665
  • Fax:
Mailing address:
  • Phone: 985-696-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number211601
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: