Healthcare Provider Details

I. General information

NPI: 1023900198
Provider Name (Legal Business Name): MACI BREAUX PETITE APRN, FNP-C
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59215 RIVER WEST DR
PLAQUEMINE LA
70764-6552
US

IV. Provider business mailing address

11324 BAINBRIDGE AVE
BATON ROUGE LA
70817-7825
US

V. Phone/Fax

Practice location:
  • Phone: 225-954-5596
  • Fax:
Mailing address:
  • Phone: 225-931-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201945
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: