Healthcare Provider Details

I. General information

NPI: 1831869973
Provider Name (Legal Business Name): JAMIE G GAUTHIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 06/27/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N LEWIS ST STE 280
NEW IBERIA LA
70563-2046
US

IV. Provider business mailing address

108 RUE LOUIS XIV
LAFAYETTE LA
70508-5739
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-8007
  • Fax: 337-235-8008
Mailing address:
  • Phone: 337-235-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number222186
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN147429
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: