Healthcare Provider Details

I. General information

NPI: 1023593647
Provider Name (Legal Business Name): JESSICA LEVETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MCCLELLAN

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 AMBASSADOR CAFFERY PKWY STE 520
LAFAYETTE LA
70503-5268
US

IV. Provider business mailing address

4023 AMBASSADOR CAFFERY PKWY STE 520
LAFAYETTE LA
70503-5268
US

V. Phone/Fax

Practice location:
  • Phone: 337-568-4325
  • Fax: 337-446-8776
Mailing address:
  • Phone: 337-568-4325
  • Fax: 337-446-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-130133
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: