Healthcare Provider Details

I. General information

NPI: 1114889029
Provider Name (Legal Business Name): MS. JYRANNE FAITH ALEXANDER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 E SAINT PETER ST
NEW IBERIA LA
70560-3752
US

IV. Provider business mailing address

1011 KIWI ST
BREAUX BRIDGE LA
70517-6624
US

V. Phone/Fax

Practice location:
  • Phone: 337-321-9204
  • Fax: 337-321-9210
Mailing address:
  • Phone: 337-342-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number012171109
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: