Healthcare Provider Details

I. General information

NPI: 1750767927
Provider Name (Legal Business Name): MINDY GAUBERT HYMEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINDY MICHELLE GAUBERT PA

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD
LULING LA
70070-4349
US

IV. Provider business mailing address

122 REFUGE DR
LULING LA
70070-3239
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-6242
  • Fax:
Mailing address:
  • Phone: 504-201-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200878
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00558
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: