Healthcare Provider Details

I. General information

NPI: 1366999401
Provider Name (Legal Business Name): JENNIFER LARROQUETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 11/01/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W PINHOOK RD STE 201
LAFAYETTE LA
70508-3735
US

IV. Provider business mailing address

106 HEYMANN BLVD
LAFAYETTE LA
70503-2322
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0770
  • Fax:
Mailing address:
  • Phone: 337-504-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: