Healthcare Provider Details

I. General information

NPI: 1053558890
Provider Name (Legal Business Name): JEFFERSON PSYCHIATRIC ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOUMA BLVD STE 401
METAIRIE LA
70006-2930
US

IV. Provider business mailing address

3901 HOUMA BLVD STE 401
METAIRIE LA
70006-2930
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-1448
  • Fax: 504-889-1452
Mailing address:
  • Phone: 504-889-1448
  • Fax: 504-889-1452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SIDNEY KENDRICK SMITH III
Title or Position: OWNER
Credential: MD
Phone: 504-889-1448