Healthcare Provider Details

I. General information

NPI: 1306392212
Provider Name (Legal Business Name): JENNIFER MATHERNE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 FLORIDA ST
MANDEVILLE LA
70448-3556
US

IV. Provider business mailing address

437 BLUE HERON LN
MADISONVILLE LA
70447-3250
US

V. Phone/Fax

Practice location:
  • Phone: 985-869-7533
  • Fax:
Mailing address:
  • Phone: 504-559-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08940
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: