Healthcare Provider Details

I. General information

NPI: 1164925426
Provider Name (Legal Business Name): VALERIE PERRAULT JACKSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD STE 201
LAFAYETTE LA
70503-2464
US

IV. Provider business mailing address

1003 EMANCIPATION BLVD
BROUSSARD LA
70518-7450
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-0650
  • Fax: 888-990-2781
Mailing address:
  • Phone: 225-718-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN141287
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09737
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: