Healthcare Provider Details

I. General information

NPI: 1891216321
Provider Name (Legal Business Name): JACQUELINE JUDICE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

1000 W PINHOOK RD STE 301
LAFAYETTE LA
70503-2460
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2017
  • Fax: 337-470-2809
Mailing address:
  • Phone: 337-264-1011
  • Fax: 337-264-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09439
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: