Healthcare Provider Details

I. General information

NPI: 1205434768
Provider Name (Legal Business Name): JACQUELINE LOCHE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 JEFFERSON ST
MANSFIELD LA
71052-2602
US

IV. Provider business mailing address

130 JEFFERSON ST
MANSFIELD LA
71052-2602
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-2700
  • Fax: 318-872-6214
Mailing address:
  • Phone: 318-872-2700
  • Fax: 318-872-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213836
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number213836
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: