Healthcare Provider Details

I. General information

NPI: 1760306419
Provider Name (Legal Business Name): JESSICA POLITZ MARTIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MARTIN LUTHER KING DR
THIBODAUX LA
70301-4886
US

IV. Provider business mailing address

1320 MARTIN LUTHER KING DR
THIBODAUX LA
70301-4886
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-2021
  • Fax: 985-447-1546
Mailing address:
  • Phone: 985-446-2021
  • Fax: 985-447-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248551
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: