Healthcare Provider Details

I. General information

NPI: 1851115349
Provider Name (Legal Business Name): JO'QUISHIA AYOI LETHERMON DNP, WHNP-BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JO LETHERMON DNP, WHNP-BC, CNM

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY STE 206
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-5239
  • Fax: 225-765-9886
Mailing address:
  • Phone: 337-470-5239
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number238012
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number238012
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: