Healthcare Provider Details

I. General information

NPI: 1780188144
Provider Name (Legal Business Name): JENNY MEQUET LAVERGNE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY CECIL MEQUET RN

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E SAINT PETER ST
NEW IBERIA LA
70560-3932
US

IV. Provider business mailing address

1019 LEBLANC RD
BREAUX BRIDGE LA
70517-7760
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-1166
  • Fax:
Mailing address:
  • Phone: 337-322-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09726
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: