Healthcare Provider Details

I. General information

NPI: 1255742656
Provider Name (Legal Business Name): JAMIE STEPHENSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD
LAFAYETTE LA
70503-2636
US

IV. Provider business mailing address

1211 COOLIDGE BLVD SUITE 300
LAFAYETTE LA
70503-2636
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-0042
  • Fax:
Mailing address:
  • Phone: 337-289-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP125574
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP07747
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: