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General NPI Number Information
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NPI Number | 1366253213
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Entity Type | Individual
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Provider Name | JEROME RICHARD JR. PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 23450 EDEN ST
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City | PLAQUEMINE
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State | LA
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Zip | 70764-2528
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Country | US
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Telephone | 225-614-2857
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Fax | 225-452-9079
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Provider Business Mailing Address
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Address Line | 4540 FORET ST
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City | ADDIS
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State | LA
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Zip | 70710-2553
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 242512
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN141212
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License Number State | LA
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