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General NPI Number Information
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NPI Number | 1164925426
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Entity Type | Individual
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Provider Name | VALERIE PERRAULT JACKSON FNP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 1000 W PINHOOK RD STE 201
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City | LAFAYETTE
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State | LA
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Zip | 70503-2464
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Country | US
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Telephone | 337-237-0650
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Fax | 888-990-2781
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Provider Business Mailing Address
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Address Line | 1003 EMANCIPATION BLVD
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City | BROUSSARD
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State | LA
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Zip | 70518-7450
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Country | US
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Telephone | 225-718-5319
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN141287
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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 | AP09737
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License Number State | LA
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