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General NPI Number Information
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NPI Number | 1063259620
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Entity Type | Individual
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Provider Name | STEPHANIE SIMON FNP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1890 W GAUTHIER RD STE 150
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City | LAKE CHARLES
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State | LA
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Zip | 70605-7119
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Country | US
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Telephone | 337-480-5559
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Fax |
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Provider Business Mailing Address
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Address Line | 604 N ACADIA RD STE 101
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City | THIBODAUX
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State | LA
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Zip | 70301-4897
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Country | US
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Telephone | 985-446-5079
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Fax | 985-447-2497
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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 | RN147315
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 237223
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License Number State | LA
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