Healthcare Provider Details

I. General information

NPI: 1174750301
Provider Name (Legal Business Name): BYRON KEITH FOURNET JR. APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 AMBASSADOR CAFFERY PARKWAY SUITE 401A
LAFAYETTE LA
70508
US

IV. Provider business mailing address

PO BOX 70
MILTON LA
70558
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6523
  • Fax: 337-456-6521
Mailing address:
  • Phone: 337-456-6523
  • Fax: 337-456-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP05857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: