Healthcare Provider Details

I. General information

NPI: 1588005128
Provider Name (Legal Business Name): JOYCE PAULETTE CHAMPAGNE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOYCE PAULETTE PETERSON NP

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 ROBERT BLVD
SLIDELL LA
70458-1648
US

IV. Provider business mailing address

664 ROBERT BLVD
SLIDELL LA
70458-1648
US

V. Phone/Fax

Practice location:
  • Phone: 985-400-5988
  • Fax: 985-867-3644
Mailing address:
  • Phone: 985-646-0360
  • Fax: 985-646-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP07363
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: