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General NPI Number Information
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NPI Number | 1124811450
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Entity Type | Organization
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Legal Business Name | JEFFERSON STREET PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 618 JEFFERSON BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70501-7206
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Country | US
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Telephone | 337-345-1709
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Fax | 337-345-4221
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Provider Business Mailing Address
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Address Line | 302 HACKER ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4508
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Country | US
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Telephone | 337-330-2576
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Fax | 337-417-9909
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR/HR
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Name | ANTOINETTE RABENALDT
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Credential |
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Telephone | 337-330-2576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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