Healthcare Provider Details

I. General information

NPI: 1215939293
Provider Name (Legal Business Name): STELLA P PREJEAN APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 RUE LOUIS XIV
LAFAYETTE LA
70508-5734
US

IV. Provider business mailing address

315 RUE LOUIS XIV
LAFAYETTE LA
70508-5734
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-9777
  • Fax: 337-269-0244
Mailing address:
  • Phone: 337-269-9777
  • Fax: 337-269-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN068456
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP03713
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: