Healthcare Provider Details

I. General information

NPI: 1275901746
Provider Name (Legal Business Name): STELLA MARIS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 COOLIDGE BLVD
LAFAYETTE LA
70503-2620
US

IV. Provider business mailing address

101 JACKSON ST
FRANKLIN LA
70538-5430
US

V. Phone/Fax

Practice location:
  • Phone: 337-210-1614
  • Fax:
Mailing address:
  • Phone: 225-333-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. JANA BETH GAUTREAUX
Title or Position: OWNER
Credential: APRN, ANP
Phone: 225-333-9559