=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598576803
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DUPUIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2025
-----------------------------------------------------
Last Update Date | 01/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1902 HIGHWAY 165 S
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71463-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 458-201-5049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1333 OBERLIN RD
-----------------------------------------------------
City | MAMOU
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70554-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-546-7798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 239511
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------