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General NPI Number Information
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NPI Number | 1003555624
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Entity Type | Individual
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Provider Name | JACOB DWAYNE LABATUT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 8585 PICARDY AVE STE 110
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City | BATON ROUGE
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State | LA
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Zip | 70809-3749
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Country | US
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Telephone | 225-767-0822
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Fax | 225-769-5424
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Provider Business Mailing Address
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Address Line | 39438 HIGHWAY 929
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City | PRAIRIEVILLE
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State | LA
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Zip | 70769-4927
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Country | US
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Telephone | 225-323-3999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN154204
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 226191
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License Number State | LA
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